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APPLICATION - USE PERMIT Ir <br /> c - SAN JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT <br /> FILE NUMBER: UP- <br /> ,�IFORN <br /> Other <br /> Describe any items of historical-or archaeological interest on-site(e.g.cemeteries or structures): NQN� <br /> Describe any on-site or off-site sources of noise or vibration (e.g.freeway noise, heavy equipment,etc. : V"4-e <br /> 6yS. /JV 1tC v..+ A, rr Cc.. C1/if7`/r/c�u� ,S'f �C v Tin <br /> /I7 i1 4. 77rz <br /> Describe any on-site or off-site sources of light of glare e. . parking lot lighting,or reflective materials used): <br /> �✓a �/� <br /> Describe an on-site or off-site source of odor e. . agricultural wastes): ON " <br /> Describe an dis lacement of eo le that will be caused b the project(e.g. numbers of people, housingunits)7 <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 /> I, 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', 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 /> L <br /> and correct. <br /> <Trw . , Lo - I <br /> N• I Signature: � Date:Gl�in1 SGCJA-.1/J'�✓J Signature: A:k � . - Date: G-10 —l.3 Signature: Date: <br /> Signature: Date: <br /> Signature: Date: <br /> F'.\DEVSWPlanning Application Forms\Use Perak(Revised 02-03'0) Page 5 of 9 <br />