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akW, <br /> -0� APPLICATION - USE PERMIT <br /> =` SAN JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT <br /> fF -Ri+`p FILE NUMBER: UP- <br /> Other <br /> Describe any items of historical or archaeob ical'merest on-site e. .cemeteries or structures <br /> oJJG <br /> Describe any on-site or off-site sources of noise or vil ration(e.g.freeway noise, heavy equipment,etc. : <br /> 6 <br /> Describe any on-site or off-site sources of li ht of are e. . arkin2 lot lighting, or reflective materials used): <br /> Describe any on-site or off-site source of odor e. . a ricultural wastes <br /> poll <br /> Describe any displacement of people that will be cused b the Rroject(e.g. numbers of people, housing units <br /> 61Yi <br /> AUTHORIZATION SIGNATURES <br /> ONLY THE OWNER OF THE PROPERTY OR AN AUTHORIZED AGENT MAY FILE AN APPLICATION. <br /> 1, 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., and that the foregoing application statements <br /> are true and correct. <br /> Print Name: /)AN �•S r <br /> �� C �j''�Sign lure: Date: <br /> Print Name: Signature: Date: <br /> Print Name: Signature: Date: <br /> Print Name: Signature: Date: <br /> Print Name: Signature: Date: <br /> F OEVSVMPlanning Application FormWse Permit.(Revised 02-0310) Page 5 of 9 <br />