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°e4�ly, APPLICATION - USE PERMIT <br /> w. < SAN JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT <br /> FILE NUMBER: UP- <br /> Other - <br /> Describe any items of historical or archaeological interest on-site e. .cemeteries or structures): <br /> � <br /> Aa— <br /> Describe <br /> `any <br /> / on-site or-off-site sources of-noise or vibration e. .freeway noise,heavy equipment etc. : <br /> /Y <br /> Describe on-site or offsite sources of light of glare e. .parking lotli titin ,or reflective-rmatedals used: <br /> N/ _ <br /> Describe any on-site or off-site source of odor e -agricultural wastes <br /> Describe any displacement of people that MH be-caused by theproject e. .numbers of people,housing units): <br /> I <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 perjurythat 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 n 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: Lt ., Signature: Date: <br /> Print Name: Signature: Date: <br /> %l <br /> `\ Print Name: Signature: Date: <br /> Print Name: Signature: Date: <br /> Print Name: Signature: Date: <br />