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i <br /> °Apu?k. APPLICATION USE PERMIT <br /> SAN JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT <br /> .,. P FILE NUMBER: UP- <br /> Other 1 <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 /> �rtSG: Typccvst_. v�rlCur-sSIt acn� t-JaLC., I S�-Pvsor-fr1,2L '4Zw5H ) <br /> Describe any on-site or off-site sources of light of glare(e.g.parking lot lighting,or reflective materials used): <br /> L-OT U &-,H-ts [ 6WI <br /> Describe any on-site or off-site source of odor(e.g.agricultural wastes): <br /> 146,4- W I N !El live) CL 1>OLA <br /> Describe any displacement of people that will be caused 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 /> 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 Owner/Agent's project. <br /> I, further, certify under penalty of perjury that I am (check one): <br /> El Legal property owner (owner includes Partner, trustee, trustor, or corporate officer) of the property(s) <br /> , <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 f <br /> III application and have been authorized to file on their behalf., and that the foregoing application statements i <br /> are true and correct. <br /> r <br /> Print Name: +i--l. pCx+tr.4 Signature: Date: <br /> Print Name: Signature: Date: <br /> Print Name: Signature: Date: <br /> Print Name: Signature: Date: <br /> Print Name: Signature: Date: <br /> F:1DF-.TFApplication Forrnftse Permit.(Revised 09-10-08) Page 5 of 9 <br />