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APPLICATION - USE PERMIT <br /> SAN JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT <br /> U% <br /> FILE NUMBER: UP- <br /> �rFo'� - <br /> Other <br /> Describe any items of historical or archaeological interest on-site(e.g.cemeteries or structures <br /> None <br /> Describe an on-site or off-site sources of noise or vibration e. .freewa noise he a a ui ment etc. <br /> Highway 1.2; ongoing a ricultural operations <br /> Describe an on-site or off site sources of Ii ht of fare e.A. arkin lot li titin or reflective materials used)-._ . <br /> Highway 12 <br /> Describe any.on-site or off-site source of odor(e.g.agricultural wastes <br /> Ongoing agricultural operations <br /> Describe any displacement of"eo le that will be caused by the promect e. .numbers of people.housin ..units : <br /> None <br /> I � <br /> AUTHORIZATION SIGNATURES <br /> I 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 /> I E] Legal property owner (owner includes partner, trustee,trustor, or corporate officer) of the property(s) <br /> involved in this application, or <br />' ❑x Legal agent (attach proof of the owner's consent to the application of the property's linvolved 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: D. Cole Frates Signature: Date: <br /> Print Name: Signature: Date: <br /> Print Name: Signature: Date: <br /> Print Name: Signature: pate: <br /> Print Name:. _ Signature: Date: <br /> M.{ <br /> FADEVSVOPlanning Application Forml Permit.(Revised 6.03-04) Page-5 of 9 <br />