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X". APPLICATI - USE PERM f <br /> r. — a SAN JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT <br /> N; <br /> FILE NUMBER: UP- <br /> Other <br /> Describe any items of historical or archaeological interest on-site(e.g, cemeteries or structures): <br /> I�U <br /> Describe an on-site or off-site sources of noise or vibration (e.g.freeway noise,hea a ui ment17etc.): fl <br /> 0 <br /> Describe an on-site or off-site sources of li ht of fare e. parkin lot li titin , or reflective materials used): <br /> �0 <br /> Describe an on-site or off-site source of odor(e.g. agricultural wastes <br /> ti <br /> Describe an dis lacement of 2eople that will be caused by the nrniect fe. . numbers of people, housin units)! <br /> AUTHORIZATION SIGNATURES <br /> ONLY THE OWNER OF THE PROPERTY OR AN AUTHORIZED AGENT MAY FILE AN APPLICATION., officers and <br /> 1, the owner/Agent agree, to defend, indemnify,against <br /> d hold County alis ng from the Ownethe County and srlAgentSs project. <br /> employees from any claim, action or proceeding <br /> I, further, certify under penalty of perjury that 1 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 heir behalfthe ., and that the cation of the forego ng application statements <br /> in this <br /> application and have been authorized to file <br /> are true and correct. <br /> ."- pate:J-_2 �- Q I Q <br /> �t�n tom`-.� « — — Signature: <br /> Print Name: Date: <br /> Signature: <br /> Print Name: Date: <br /> Signature: <br /> Print Name: Date: <br /> Signature: <br /> Print Name: Date: <br /> Print Name: <br /> Signature: <br /> Pa e5of9 <br /> F:IDEvsvclptanning Application Forms\Use Permit.(Revised 05-11.08) g <br />