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uif <br /> z: <br /> - �? • <br /> APS- i. ICATION f NTERTHINMENT PERMIT <br /> MIT <br /> � W< SAN JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT <br /> FILE NUMBER : <br /> r;0 <br /> Other <br /> Describe any items of historical or archaeological interest on -site ( e .g . cemeteries or structures ) : l' DY <br /> Describe any on -site or off-site sources of noise or vibration (e . g . freeway noise , heavy equipment , etc . : <br /> Describe any on -site or off-site sources of light of glare e . g . parking lot lighting , or reflective materials used V, <br /> Describe any on -site or off-site source of odor e . g . agricultural wastes ) : <br /> Describe any displacement of people that will be caused by the project (e . g . numbers of people , housing units ) : O VLA <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 /> Print Name : 41 le �C CNN I Signature : Vo Date : <br /> Print Name : © L Signature : Date : ' <br /> Print Name : Signature : Date : <br /> Print Name : Signature : Date : <br /> Print Name : Signature : Date : <br /> F :\Application Forms & Handouts\Planning Application Forms\ Entertainment Permit .docPage 6 of 10 <br /> . ( Revised 02- 03- 10 ) <br />