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�.tn. <br /> APPLICATION — USE PERMIT <br /> ani J <br /> SAN JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT <br /> FILE NUMBER: UP- <br /> eteries or structures <br /> FO <br /> Other <br /> Describe an items of historipl or archaeob ical interest on-site e. .cem <br /> Describe an on-site or off-site sources of noise or vibration e. .freeway noise heavy equipment,etc. <br /> Describe an on-site or off-site sources of light of glare e. .parkin lot li hang,or reflective materials used : <br /> Describe an on-site or off-site source of odor e. .agricultural wastes): <br /> Describe an is lacement of oeople that will be caused by the ro'ect 1e. . numbers of eo le housin 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 /> 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'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 /> Signature: <br /> Date: <br /> Print Name: Q f lr'4�bCe. 9 <br /> Print Name: Signature: <br /> Date: <br /> � m U <br /> Signature: <br /> Date: <br /> Print Name: <br /> Signature: Date: <br /> Print Name: Signature: Date: <br /> Print Name: <br /> F1DEVsvc%Nanning Apphution FormsNUse Permit.(Revised 02113-10) Page 5 of 9 <br />