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oP� tN. APPLICATION — USE PERMIT <br /> SAN JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT <br /> PILE NUMBER: UP- <br /> Other <br /> Descri a items of historical or archaeological interest on-site(e.g. cemeteries or structures <br /> Describe any on-site or off-site sources of noise or vibration(e.g. freeway noise,heavy equipment, etc. : / <br /> G ��' S ' <br /> Describe site.or off-site sources of light of lare e. parkinglot li htin ,or reflective materials used <br /> Describe n site or off-site source of odor (e.g. agricultural wastes): <br /> Describe a w displacement of people that will be caw5eq__Iqy,the ro ect e. . numbers of eo le, housing units): <br /> AUTHORIZATION SIGNATURES <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 /> 1, further, certify under penalty of perjury that I 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 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 /> Signature: D Date: <br /> Print Name: Signature: Date: <br /> Print Name: <br /> Signature: Date: <br /> Print Name: <br /> Signature: Date: <br /> _ _� f - <br /> Print Name: __._.__ Signature: Date: <br /> F TEVSVC1Pianning Application FormslUse Permit.(Revised 05-11-09) Page 5 of 9 <br />