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APPLICATION - ZONE RECLASSIFICATION <br /> SAN JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT <br /> . A.. FILE NO: ZR- <br /> rF01>H <br /> Other <br /> Describe any items of historical or archaeological interest on-site e. .cemeteries or structures): <br /> Describe any on-site or off-site sources of noise or vibration e. .freeway noise heavy equipment,etc.): <br /> 14 <br /> Describe any on-site or off-site sources of light of glare(e.g. parking lot lighting,or reflective materials used): <br /> Describe any on-site or off-site source of odor e. .agricultural 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 /> J 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: i Signature: Date: <br /> Print Name: 4J� Signature: Date: <br /> Print Name: Signature: Date: <br /> Print Name: Signature: Date: <br /> Print Name: Signature: Date: <br /> F:\DEVSVS\PIanningAppIm_afion Foms\ZONE RECLASSIFICATION Page 5 of 5 <br /> (Rev.05-11-09) <br />