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1 <br /> °R-- � APPLICATION - USE PERMIT <br /> SAN JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT <br /> P <br /> FILE NUMBER: UP- <br /> hkb <br /> Describe any items of historical or archaeolo icai interest on-site(e.g.cemeteriesor structures): <br /> EDescribe any on-site or off-site sources of noise or vibration(e.g.freeway noise,heavy a ui ment,etc.): <br /> I = <br /> too( e <br /> Describe any on-site or off-site sources of light of glare e. .paridnq lot lighting,or reflective materials used): <br /> 5 a," L4(kmiAieir <br /> Describe any on-site or off-site source of odor e. .agricultural wastes): <br /> b <br /> Describe any displacement of people that will be caused by thero'ect(e.g.numbers of people,housing units): <br /> b k, 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 /> VLegal 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: <br /> K �S'��y Signature: CLe Date: /a / <br /> Print Name: Signature: Date: <br /> Print Name: Signature: Date: <br /> ' Print Name: Signature: Date: <br /> Print Name: Signature: Date: <br /> 4 <br /> FADEMCIPlanning Application FormsMe Permit.(Revised 02-03-10) Page 5 of 9 <br />