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r _ <br /> APPLICATION — USE PERMIT <br /> t SAN JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT <br /> FILE NUMBER: UP- <br /> Other <br /> Describe any items of historical or archaeol 22ical interest on-site e. .cemeteries or structures): <br /> &&A(� EEE <br /> Describe any on-site or off-site sources of noise or vibration(e.g.freeway noise,heayy equipment,etc. <br /> Interstate 5(A rosimatcly Igo,from site) <br /> Describe any on-site or off-site sources of light of glare(e.g.parkinglot lighting,or reflective materials used): <br /> r D <br /> C11- I-el 'oi <br /> Describe an onsite or off-site source of odor e. .a ricullural wastes): <br /> U404- r I 4 i /C W 1t.Iil �I HL l04� <br /> Describe andis lacement of people that will be caused b the ro'ecI e. .numbers of PeODle,housing units): <br /> �t7 H <br /> AUTHORIZATION SIGNATURES <br /> ONLY THE OWNER OF THE PROPERTY OR AN AUTHORIZED AGENT MAY FILE AN APPLICATION. <br /> I, 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 County arising from the Owner/Agent's project. <br /> I, 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 /> ❑ Legal agent(attach proof of the owner's 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 /> •falx <br /> Print Name: <br /> rd fp-r-ry-f>=fir.-tT-_.Ca'FL'>iZr19 Signature: fJFate. I /— 1 ?— 13 <br /> Print Name: Signature: <br /> Dale: <br /> Print Name: Signature: <br /> Dale: <br /> Print Name: Signature: Dale:______ is <br /> Print Name: Signature: <br /> Date: <br /> F;IDEVSVCIPI nnmq Applicopon Forms%Use Pent t.(Ra sed 02-03-10) Page 5 of 9 <br />