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t <br /> .. APPLICATION <br /> SANJOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT <br /> FILE NUMBER: UP <br /> Other <br /> Despite any ftm of histdcal or ardymcbgical interest e. _cmuftrm or shuck es: i <br /> tc�:v <br /> Describe ofl sffe oroff-sft sources of frog or (#a PRmM92EP,heavyeguynmL ebb. <br /> t �Z Nit'h_ <br /> Describe gM ore-site or off-eft sources of Wd of g1me e=q.Parking lot Yg LMM.or n0bcbm mateials used <br /> Describe any ort-site or off-site source of odor (e . <br /> r <br /> Descn'be Dud vA be ea.nurfilms of psopfts tot no unAj <br /> its <br /> r <br /> AUTHORIZATION SIGNATURES <br /> ONI-Y THE OWMER OF THE PROPERTY OR M AUTHOWED AGBff MAY FILE M APPLICATION. <br /> 1, the agree, to defend, indemnify, and hold harffdess the County and its agants, officers and <br /> employees from any damn,action or proceeding agamst um County army from the Ow nWAgenrs project. _ <br /> 1,further, uncW penalty of perjury that 1 am(die&one): <br /> ❑ Legal property owner(owner includes partner,tnJSt8e,InIStDr.or a afffc er)of the (s) <br /> involved in this application,or <br /> Legal agent(attach proof of the owner's consent tD the application of the propeWs involved in Oils <br /> application and have been auffmized to file on VoIr b~-,and that the foregoing application staternents <br /> are true and correct. <br /> Print t+iarr r?ct _ Date: <br /> Print Name: Dater <br /> f'rset Name: .�Ja �L t� p,D��aatm 1`LZ•1 Z y f ✓ <br /> Print Name: l Data: <br /> f'rset Name- Date: <br /> FVEVWMPW V FmvAUse ttma.If mW 02-W10) Page 5 of 9 <br />