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APPLICATION - USE PERMIT <br /> SAN JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT <br /> FILE NUMBER: UP- <br /> \i;Fo <br /> Other <br /> giotemsolso <br /> istorical or archaeolo ical interest on-site e. .cemeteries or structuresnr off-site sources of noise or vibration e. .freewa noise, hea a ui ment,etc. <br /> 1 � 7 �r off-site sources of light of glare e. parkinglot lighting,or reflective materials used): <br /> Describe any on-site or off-site source of odor(e.g. a ricultural wastes): <br /> 12 <br /> S Tr r� C SPE df1 —, t` ! -/IJ i , j — mol L `Ge' N <br /> Describe any displacement of people that will be caused by the prolect(e.g. numbers of people, housing units): <br /> l� <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 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: Lr A;&G C f3'k. Signature: -LC Date: Qle-) <br /> Print Name::IreA -','r �t2 L-L /V Signature: Date: 1 <br /> Print Name: UL,'A;9 1,J6 11TT- Signature: / ii�.,t.ip ,Date: /c 114a <br /> Print Name: Signature: Date: <br /> Print Name: Signature: Date: <br /> F'\DEVSVC\Planning Application Forms\Use Permit (Revised 1-2-03) Page 5 of 9 <br />