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APPLICATICA - USE PERMIT <br /> SAN JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT <br /> FILE NUMBER: UP- <br /> -Ofh <br /> Describe any items of historical or archaeological interest on-site (e.g.cemeteries or structures): <br /> vs Tpcc t c uc_ kV_01,hS_C t-0 (AL <br /> Describe any on-site or off-site sources of noise or vibration(e. freeway noise, heavy equipment, etc.): <br /> _S EtJi�_7,C,42 fV11 L 4!�S T v - a/7 i <br /> Describe any on-site or off-site sources of light of glare(e.g. parking lot lighting,or reflective materials used): <br /> SDOWA1 V�L-6 rroiC A�9XW� {.sir ),.)A-V <br /> 6�tl,)T)�A t\J( t,� <br /> Describe any on-site or off-site source of odor(e.g. agricultural wastes): <br /> -2.V OWE Vk?0� ^r DD01Z <br /> Describe any displacement of people that will be caused by the project(e.g. numbers of people, housiDq unit <br /> PL. <br /> AUTHORIZATION SIGNATURES <br /> ONLY THE OWNER OF THE PROPERTY OR AN AUTHORIZED AGENT MAY FILE AN APPLICATION. <br /> 1, the Owner/Agent agree, to defend, indemnify, and hold harmless the County and its agents, officers and <br /> employees from any claim, action or proceeding against the Owner/Agent's project. <br /> 1, further, certify under penalty of perjury that I am (check one): <br /> Legal property owner (owner includes partner, trustee, trustor, or corporate officer) of the property(s) <br /> involved in this application, or <br /> F1 Legal agent (attach proof of the owners consent to the application of the property's involved in this <br /> application and have been authorized to file on their behalf., and that the foregoing application statements <br /> are true and correct. <br /> Print Name: <br /> bAmSignature: A;--Date: C0!'— <br /> Print Name: Signature: Date: <br /> Print Name: Signature: Date: <br /> Print Name: Signature: Date: <br /> Print Name: Signature: Date: <br /> F:\D EVSVOPlanning Application Forms\Use Permit.(Revised 1-2-03) Page 5 of 9 <br />