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.;.�a2 APPLICA) iuN — USE PERMIT <br /> N I < SAN JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT <br /> • cP/ FILE NUMBER: UP- <br /> Other <br /> Describe any items of historical or archaeological interest on-site(e.g.cemeteries or structures): <br /> C tV t <br /> Describe any on-site or off-site sources of noise or vibration(e.g.freeway noise,heavy equipment,etc. : <br /> Describe an on-site <br /> l or off-site`so(u�rces of light of glare e. parking lot lighting,or reflective materials used): <br /> V� V1r 1:.C'� A k�0 G �`�i�ecx 1 ►4 C i� V�' G�t�� lcv� c. <br /> Describe any on-site or off-site source of odor(e.g.agricultural wastes): <br /> oi� i1 �nhC <br /> 1 J�R- <br /> Describe any displacement of people that will be caused by the project(e.g. numbers of people,housing units): <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 /> 7I, furt er, 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 /> �/�f� <br /> Print Name: ) /t/ICU Signature: l Date: <br /> Print Name: Signature: Date: <br /> Print Name: Signature: Date: <br /> Print Name: Signature: Date: <br /> Print Name: Signature: Date: <br />