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APPLICATION - ZONE RECLASSIFICATION <br /> SAN JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT <br /> FILE NO: ZR- <br /> Other <br /> Describe anV items of historical or archaeological interest on-site(e.g.cemeteries or structures): <br /> Describe any on-site or off-site sources of noise or vibration e. .freeway noise,heavy a ui ment,etc.): <br /> N <br /> Describe any on-siteoroff-site sources of li ht of glare e. . parkinglot fighting,or reflective materials used): <br /> N <br /> Describe any on-site or off-site source of odor e. . agricultural wastes): <br /> Describe any displacement of people that will be caused bv the promect e. . numbers of people,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 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 /> L� 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 owners 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: t'e� We-5'ffon z�— Signature:`- 9 Date: <br /> Print Name: Signature: Date: <br /> Print Name: Signature: Date: <br /> Print Name: Signature: Date: <br /> Print Name: Signature: Date: <br /> FADEVSV&Planning Applimbon Fonns\ZONE RECLASSIFICATION Page 6 of 6 <br /> (Rev.05-11-09) <br />