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AW <br /> APPLICATION - USE PERMIT <br /> SAN JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT <br /> c 4/ <br /> FILE NUMBER. UP- - <br /> Other <br /> Describe any items of historical or archaeological interest on-site (e.g. cemeteries or structures), <br /> hdo JE-:: exl57r. <br /> Describe any on-site or off-site sources of noise or vibration (e.g.freeway noise, heavy equipment, etc. : <br /> -PRoJ.C-,--rdr-et�^CIotJ VVluL NOT N f `516"WR.,C�T <br /> wrrti -n-ir �Xty i tN» r tJc�t'['t ot�t� r ��2�r t Tt6�4 �-tacs pe,-. <br /> Describe any on-site or off-site sources of li ht of glare(e.g. parkinglot lighting,or reflective materials used): <br /> AN> AW-"61HTIN6r WQ-L-P-LV- SI-"-E;!• <br /> Describe any on-site or off-site source of odor(e.g. agricultural wastes): <br /> Describe any displacement of people that will be caused by the project e_ . numbers of people, housing units): <br /> - <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 /> 1, 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: ySignature. � Date:D/'J -/d <br /> Print Name: _.� _ Signature: -. Date: <br /> Print Name: _ Signature: Date: <br /> Print Name: ---_................ Signature: Date: <br /> Print Name: Signature: __.. Date: <br /> F:IDEVSVC0anning Application Forms%Use Permit (Revised 1-2-03) Page 5 of 9 <br />