Laserfiche WebLink
taPq�cO APPLICATION — USE PERMIT <br /> c <br /> SAN JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT <br /> p. FILE NUMBER: UP- <br /> 4tiko Rt'� <br /> Other <br /> Describe any items of historical or archaeolo iwi interest on-site e. .cemeteries.or structures): <br /> Describe any on-site or off-site sources of noise or vibration e. .freeway noise, heavy equipment,etc. <br /> �e1aN Ls M leVn CIO MAAGVYISAnyo� tVv--. <br /> Describe any on-site or off-site sources of light of glare e. .parking lot lighting,or reflective materials used): <br /> ` <br /> `l1l \9— <br /> Describe any on-site or off-site source of odor e. .agricultural wastes): <br /> Describe any displacement of people that will be caused by the proiect e. .numbers of people,housing units): <br /> lV� <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 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 prop erty(s) <br /> involved in this application, or t4 N G- fA(£ µ ifs 2 2F F(LE►1e1+ 2t� /'A R tt U& <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. (j <br /> Print Name:'%` tl U6krdtEAl' WII Lo- Signature: Date _I 7 <br /> Print Name: _ Signature: Date: <br /> Print Name: Signature: Date: <br /> Print Name: Signature: Date: <br /> Print Name: Signature: Date: <br /> FADEVSVLAPlanning Application FormsWsa Permit.(Revised 6-03-04) Page 5 of 9 <br />