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APPLICATION -- USE PERMIT <br /> 1 °` SAN JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT <br /> FILE NUMBER: UP- <br /> Other <br /> Describe any items of historical or archaeological Interest on-site Je. .cemeteries or structures), <br /> None known <br /> Describe any on-site or off-site sources of noise or vibration e. .freewa noise h2Mequipment,etc,): <br /> None <br /> [Describe any onsite or offsite sources of Ilht of giare e. .parking lot lighting,or reflective materiats used <br /> There will be minir.:al 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 /> Descdbe an da facement of people that will be caused by tyre project e. .numbers of people.housing units): <br /> None <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.,an th the foregoing application statements <br /> are true and correct. <br /> Print Name: A, Michael Souza Signature: Date: 11/1'7/11 <br /> Print Name: Signature: Date: <br /> Print Name: Signature: Date: <br /> Print Name: Signature: Date: <br /> Print Name: Signature: Crate: <br /> F:iDFVSVC%R'snning AppNnuon FumtsWae Perrnd.iftvisad 0243-10) Page 5 of 9 <br />