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/6�wkwy APPLICATION - ZONE RECLASSIFICATION <br /> SAN JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT <br /> \ FILE NO. ZR- <br /> .- �p <br /> Other <br /> Describe an items of historical or archaeological interest on-site(e.g.cemeteries or structures): <br /> CNi--- <br /> Describe any on-site or off-site sources of noise or vibration (e.g. freeway noise, heavy equipment, etc. : <br /> FA VR,A^4C r574?t,*l PIY7 JF/r/ _ <br /> Describe any on-site or off-site sources of light of glare(e.g.parkinglot lighting, or reflective materials used): <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): <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 /> �' <br /> Print Name: �_, � �11'('-// Signature: =` '' Date: <br /> Print Name: Signature: Date: <br /> Print Name: Signature: Date: <br /> Print Name: Signature: Date: <br /> Print Name: Signature: Date: <br /> F:\DEVSVS\Planntng Application Forms\ZONE RECLASSIFICATION Page 5 of 5 <br /> (Rev 05-11.09) <br />