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e 1 <br /> 1 <br /> ' APPLICATION - USE PERMIT <br /> < SAN JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT <br /> FILE NUMBER: UP- <br /> Other <br /> Describe an items of historical or-archaeo)o ical interest on-site(e.g.cemeteries or structures): y�iVE <br /> Describe an on-site or off-site sources of noise or vibration (e.g. freewaynoise, heavya ui ment,etc. : 6it./E <br /> Describe an on-site or off-site sources of Il ht of glare e. parkinglot lighting,or reflective materials used): 6 E <br /> Describe an on-site or off-site source of odor(e.g. agricultural wastes): O/t.E <br /> Describe an dis lacement of people that will be caused b the ro'ect(e.g. numbers of people, housingunits): IVZ>AJ6 <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 /> ❑ 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 /> ck <br /> Print Name: bn�Q:� 7 Signatu Date: t+r5—oZ0-oZ0/ <br /> Print Name: Signature: Date: <br /> Print Name: Signature: Date: <br /> Print Name: Signature: Date: <br /> Print Name: Signature: Date: <br /> F:\DEVSVC\Planning Application Fonns\Use Permit.(Revised 02-03-10) Page 5 of 9 <br />