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ylN APPLICATION - USE PERMIT <br /> '4•"^Ef s+c <br /> SAN JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT <br /> n .. FILE NUMBER: UP- <br /> 00W <br /> Describe any Items of historical or archaeo icsl interest on-site e. .cemeteries or structures): None <br /> Describe any on-site or oft-site sources of noise or vibration e. .fieeway noise heavy equipment,etc. . Site is located next to <br /> Hwy 4. <br /> Describe any on-she or off-site sources of light of glare e. .parking lot lighting.or reflective materials used): None. <br /> Describe any on-she or off-site source of odor e. . a ricultural wastes): None. <br /> Describe any displacementof people that will be caused by the proied e. .numbers of people,housing units): 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 /> 1,further, certify under penalty of perjury that I am (check one): <br /> KLegal 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: V' C C^ S/N Signature: Date: <br /> Print Name: Signature: Date: <br /> Print Name: Signature: Date: <br /> Print Name: Signature: Date: <br /> Pnnt Neme: Signature: Date: <br /> FADEvsvc,Planning Application FOtmakUm Permit.Mwisa0 02-03-10) Page 5 of 9 <br />