Laserfiche WebLink
APPLICATION - USE PERMIT <br /> f 4 SAN JDAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT <br /> ki .� <br /> y/ FILE NUMBER: UP- <br /> Other <br /> Describe any Items of historical or archa Icer interest on e. .cemeteries or structures); <br /> Describe any on-site or off-site sources of noise or vibration e. .freeway noise,heayy equipment,etc. <br /> Describe any on-site or off-site sources of fight of glare e. .parldno lot f htl ,or reflective materials used): <br /> Describe any on-site or off-Ae source of odor(e.g.agrilcuitural wastes); <br /> Describe any dl3piacemeni of people that velli be caused by The project(e.14.numbers of people,hausin units <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 /> 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 /> L 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 the foregoing application statements <br /> are true and correct. <br /> Print Name: /G/. Signstwe: Crate: <br /> Print Name: Signature: _ _ Date: <br /> Print Name: Signature: Date: <br /> Print Name: Signature: Date: <br /> Print Name: Signature: Date: <br /> F IDEVSVClPlanning Apphcabon FormalUse Permt (Revised 02-03.10) Page S of 9 <br /> .................................................................................................. .... .. .. ._................... <br />