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APPLICATION - ZONE RECLASSIFICATION <br /> .W1 SAN JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT <br /> FILE NO: ZR- <br /> Other <br /> Describe any items of historical or archaeological interest on-site(e.g.cemeteries or Structures): <br /> A4"6 <br /> Describe any on-site or off-site sources of noise or vibration e. .freeway noise,heavy equipment,etc. : <br /> N e <br /> Describe any on-site or off-site sources of light of glare e. .parking lot lighting, or reflective materials used): <br /> F, <br /> Describe any on-site or off-site source of odor e. . a ricultural wastes): <br /> Describe any displacement of people that will be caused by the project e. .numbers of people, housing 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 employees from any claim. <br /> 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,grantor,or corporate officer)of the property(s)involved in this <br /> application,or <br /> Legal agent(attach proof of the owner's consent to the application of the property's involved in this application and have been <br /> authorized to file on their behalf„ and that the foregoing application statements are true and correct. <br /> Print Name: ♦Ju Ll Signature: Date: <br /> Print Name: Signature: Date: <br /> Print Name: Signature: Date: <br /> Print Name. Signature: Date. <br /> Print Name: Signature: Date: <br /> FADEVSMPIanning Apolitalmn FormsXZONE RECLASSIFICATION Page 5 of 5 <br /> (Rev.05.11.09) <br />