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APPLICATION - ZOhvt RECLASSIFICATION <br /> N: < <br /> SAN JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT <br /> '4 <br /> FILE NO: ZR- <br /> 9 %F0 ` <br /> Other <br /> Describe an items of historical or archaeological interest on-site(e.g.cemeteries or structures): None <br /> Describe any on-site or off-site sources of noise or vibration (e.g.freeway noise, heavy equipment, etc. : None <br /> Describe any on-site or off-site sources of light of glare(e.g. parkinglot lighting, or reflective materials used): None <br /> Describe any on-site or off-site source of odor e. .agricultural wastes): None <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 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 o�n,their <br /> behalf., and that the foregoing application statements are true and correct. <br /> Print Name: �O� ���'rr�W Signature: Date: <br /> Print Name: Signature: Date: <br /> Print Name: Signature: Date: <br /> Print Name: Signature: Date: <br /> Print Name: Signature: Date: <br /> FADEVSVMPlanning Application FomIs\ZONE RECLASSIFICATION Page 5 of 5 <br /> (Rev.12-07-06) <br />