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0. <br /> APPLICATION - USE PERMIT <br /> J.: <br /> SAN JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT <br /> FILE NUMBER: UP <br /> Other <br /> Describe any items of historical or archaeological interest on-site (e.g. cemeteries or structures): <br /> NO►jE. <br /> Describe any on-site or off-site sources of noise or vibration (e.g.freeway noise, heavy equipment,etc. : <br /> N,tcNL <br /> Describe any on-site or off-site sources of light of glare (e.g. parkinglot lighting, or reflective materials used): <br /> Describe any on-site or off-site source of odor(e.g. a ricultural wastes): <br /> cel l7►�'� <br /> Describe any displacement of people that will be caused by the project(e.g. numbers of people, housing units): <br /> NO-------------- <br /> r�I� <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 /> I, further, certify under penalty of perjury that I am (check one).- <br /> Legal <br /> ne):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: 4\ Z Signature! 4 <br /> Print Name: <br /> Date: 30. OS <br /> Signature: Date: <br /> Print Name: <br /> Signature: Date: <br /> Print Name: — <br /> Signature: Date: <br /> Print Name: <br /> — Signature: <br /> Date: <br /> FiDEVSMPlanning Application Forms\Use Permit.(Revised 1-2-03) <br /> Pane 5 of 9 <br />