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APPLICATION -- ENTERTAINMENT- PERMIT <br /> 7.•'�E.Co.G <br /> 2' <br /> i x SAN JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT <br /> FILE NUMBER: <br /> Other <br /> Describe any 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 /> Describe any on-site or off-site sources of light of glaro(e.g.parkinglot lighting,or reflective materials used): <br /> Describe any on-site or off-site source of odor(e.g.agricultural wastes), <br /> Describe any displacement of people f t will be c used by the project(e.g.numbers of people,housing units): <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 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: Signature: Date: <br /> Print Name: �d"t v`�4.n Signature: Date: <br /> Print — <br /> Print Name: Signature: Date: <br /> Print Name: Signature: Date: <br /> PTEVSVOPlanning Application FormslEntertalnmant Permit.doc Page 6 of 10 <br /> (Revised 02-03-10) <br />