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°eg`'if" ° APPLICATION - USE PERMIT y :< SAN JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT FILE NUMBER: UP- A��FOR� Other Describe any items of historical or archaeological interest on-site(e.g.cemeteries or structures): None Known Describe any on-site or off-site sources of noise or vibration (e.g.freeway noise, heavy equipment, etc. : Heavy equipment use during construction . Normal traffic noise during use of facility. Describe any on-site or off-site sources of light of glare(e.g. parkinglot lighting, or reflective materials used): Parking lot lighting will be designed to minimize light escaping from the property Describe any on-site or off-site source of odor(e.g. agricultural wastes): None Anticipated Describe any displacement of people that will be caused by the project(e.g. numbers of people, housing units): None Known AUTHORIZATION SIGNATURES ONLY THE OWNER OF THE PROPERTY OR AN AUTHORIZED AGENT MAY FILE AN APPLICATION. I, the Owner/Agent agree, to defend, indemnify, and hold harmless the County and its agents, officers and employees from any claim, action or proceeding against the Owner/Agent's project. I, further, certify under penalty of perjury that I am (check one): Z__Le_gal property owner (owner includes partner, trustee, trustor, or corporate officer) of the property(s) involved in this application, or ❑ Legal agent (attach proof of the owner's consent to the application of the property's involved in this application and have been authorized to file on their behalf., and that the ore oing application statements are true and correct. Print Name: r�2)iUIli Cs Signature: Date: Print Name: Signature: Date: Print Name: Signature: Date: Print Name: Signature: Date: Print Name: Signature: Date: F:\)EVSVC\Planning Application Forms\Use Permit.(Revised 6-03-04) Page 5 of 9