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APPLICATION - USE PERMIT <br /> 1 SAN JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT <br /> '. FILE NUMBER: UP- <br /> '- Ofher - <br /> Describe any items of historical or archaeological interest on-site e. .cemeteries or structures): <br /> None known <br /> Describe any on-site or off-site sources of noise or vibration e. .freeway noise,heavy equipment,etc. : <br /> None <br /> Describe any on-site or off-site soumes of light of glare e. .parking lot II ghting,or reflective materials used: <br /> There will be minimal parking lot and security lighting. <br /> Describe any on-site or off-site source of odor e. .agricultural wastes): <br /> Dairy to the north <br /> Describe any displacement of people that will be caused by the project e. .numbers of people,housing units): <br /> None <br /> AUTHORIZATION SIGNATURES <br /> remployees <br /> Y THE OWNER OF THE PROPERTY OR AN AUTHORIZED AGENT MAY FILE AN APPLICATION. <br /> Owner/Agent agree, to defend, indemnify, and hold harmless the County and its agents, officers and <br /> from any claim, action or proceeding against the County arising from the Owner/Agent's project. <br /> her, 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.,an th the foregoing application statements <br /> are true and correct. <br />' Print Name: A. Michael Souza Signature: YAR Date: 11/17/11 <br /> Print Name: - Signature: V1 Date: <br /> Print Name: Signature: Date: <br /> Print Name: Signature: Data: <br /> Print Name: Signature: Date: <br />+ FdDEVSVCIPianning Application FpvnslUsa Permit.(Revised 020340) Page 5 of 9 <br /> 1 <br />