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°P4utN c APPLICATIu►N -- USE PERMIT �.• _.�r� .oG SAN JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT �•. ._ .�P FILE NUMBER: UP- Other Describe any items of historical or archaeological interest on-site(e.g. cemeteries or structures): { )O Describe any on-site or off-site sources of noise or vibration(e.g. freeway noise, heavy equipment, etc. : d N Describe any on-site or off site sources of light of glare (e.g. parkinglot lighting, or reflective materials used): 1 Describe an on-site or off-site source of odor(e.g. agricultural wastes): Describe any dis lacement of people that will be caused by the project(e.g. numbers of people, housing.units): f QNE AUTHORIZATION SIGNATURES ONLY THE OWNER OF THE PROPERTY OR AN AUTHORIZED AGENT MAY FILE AN APPLICATION. I, the Owner/Agent agree, to defend, indemnify, and hold harmless the County and its agents, officers and employees from any claim, action or proceeding against the County arising from the Owner/Agent's project. I, further, certify under penalty of perjury that I am (check one): Legal property owner (owner includes partner, trustee, trustor, or corporate officer) of the property(s) involved in this application, or ❑ Legal agent (attach proof of the owner's consent to the application of the property's involved in this application and have been authorized t on their behalf., and that the foregoing application statements are true and correct. Print Name: _��n R �,�� Signature: ate: 1-2,1- Print -2,1-Print Name: Signature: Date: Print Name: Signature: _ Date: Print Name: Signature: Date: Print Name: _� Signature: Date: