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APPLICATION - ENTERTAINMENT PERMIT <br /> Y. F <br /> SAN JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT <br /> FILE NUMBER., <br /> I <br /> Other <br /> Describe any items of historical or archaeological interest on-site Le.g.cemeteries or structures <br /> f d <br /> Describe an on-site oroff-site sources of noise or vibration (e.g. freeway noise, heav a ui men[, etc.): <br /> o� <br /> Describe an on-site or off-site sources of light of glare (e.g. parkinglot lighting, or reflective materials used): <br /> Describe an on-site or off-site source of odor(e.g. agricultural wastes): <br /> one <br /> Describe an is lacement of people that will be caused by the eroiect(e.g. numbers of people, housing units): <br /> i <br /> AUTHORIZATION SIGNATURES <br /> r:ON:L�YTHE 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 /> i <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 /> [Print-Name: <br /> pplication and have been authorized to file on their behalf., and that the foregoing application statements <br /> re true and correct. <br /> ame: r <br /> Signature: Date: �- <br /> ame: Signature: i <br /> Date: <br /> _ .. Signature: __. {late-ame: Signature: Date:ame: Signature: Date: <br /> F:\0EVSVCnanning Application FormMEnlertainment Permit.doc Page 6 of 10 <br /> .(Revised 02.03-10) J <br /> { <br />