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i APPLiCATiON - USE PERMIT SAN JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT FILE NO.: UP- - .................. Describe any items of historical or archaeological interest on-site(e.g. cemeteries or structures): None present. Describe any on-site or off-site sources of noise or vibration(e.g. freeway noise, heavy equipment, etc.): Site may experience possible freeway noise from Interstate-5 which is a quarter mile to the west. Describe any on-site or off-site sources of light or glare (e.g.parking lot lighting, or reflective materials used): Site will be illuminated with standard parking lot lights, identification signages, fuel prices. No reflective materials. Describe any on-site or off-site sources of odor(e.g. agricultural wastes): None expected other than vehicle and diesel exhausts. Describe any displacement of people that will be caused by the project(e.g.numbers of people, housing units): None. : < 1, the Owner/Agent agree, to defend, indemnify, and hold harmless the County and its agents, officers and employees from'any claim, action or proceeding against the County arising from the Owner/Agent's project. i 1, further, certify under penalty of perjury that i am(check one): i 0 Legal property owner(owner includes partner, trustee, trustor, or corporate officer)of the property(s involved in this application, or Legal agent(attach proof of the owner's consent to the application) of the owner of the property(s) involved in this application and have been authorized to file on their behalf, and that the foregoing application statements are true and correct to the best of my knowledge and belief. i 1 r Print Name: Jeff Kjeldsen _ Signature: _ ,�. �� a< Date: -2,/Z S It/ Print Name: Signature: Date: Print Name: Signature: Date: Print Name: Signature: Date: Print Name: Signature: Date: r