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APPLICATION - USE PERMIT <br /> SAN JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT <br /> k <br /> .• FILE NUMBER: UP- <br /> Other <br /> Describe any hems of historical or archaeological interest onsite(e.g.cemeteries or structures): <br /> A. <br /> Describe any onsite or off-site sources of noise or vibration(e.g.freeway noise heavy equipment,etc. :Describe any on-site or off-site sources of Iifilit of glare(e.g.parking lot F htin ,or refiectNe materials used): <br /> N A. <br /> Describe any onsite or off-site source of odor(e.g.agricultural wastes <br /> A v..� a. o V�o✓�. <br /> Describe any dispfaclent ofpeoLle that will be caused by the proiect(e-q.numbers M people,housing units): <br /> \h A M <br /> AUTHORIZATION SMNATURES <br /> ONLY THE OWNER OF THE PROPERTY OR AN AUTHORIZED AGENT MAY FILE AN APPLICATION. <br /> — 1, 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 /> Q� 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: 1MA0.`L V<�Y+1\ Signature: Date: 4Z1 l t <br /> Print Name: Signature: _ Date: <br /> -- Print Name. Signature: Date: <br /> Print Name: Signature: Date: <br /> Print Name: Signature: Date: <br /> F:toevsVOPianniM Appication Fo.m Wm Pemft.(Rsvise os-oa-ro) Page 5 of 9 <br />