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APPLICATII' I - USE PERMIT <br /> I SAN JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT <br /> FILE NUMBER: UFP Av o 8 Q t)n if'< 5 <br /> Other <br /> Describe any items of historical or archaeological interest on-site e. .cemeteries or structures): <br /> Previously assessed in ER-93-1 . <br /> Describe any on-site or off-site sources of noise or vibration (e.g.freeway noise, heavy equipment,etc. : <br /> See attached project description. <br /> Describe an on-site or off-site sources of light of glare e. . parking lot lighting,or reflective materials used): <br /> See attached project description. <br /> Describe any on-site or off-site source of odor e. .agricultural wastes): <br /> See attached project description. <br /> Describe any displacement of people that will be caused by the project e. .numbers of people, housing units): <br /> one <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: Michael K. Repetto Signature: K. Date: 12/20/2007 <br /> Print Name: Signature: Date: <br /> Print Name: Signature: Date: <br /> ^,int Name: Signature: Date: <br /> int Name: Signature: Date: <br />