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� <br />' <br /> , <br /> FILE NO: ZR- <br /> SAN JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT <br /> Describe any items of historical or archaeological interest on-site(e.g.cemeteries or structures): <br /> NoneKnown <br /> Describ'e any on-site or off-site sources of noise or vibration(e.g.freeway noise,heavy equipment,etc.): <br /> Adjacen't to State Route Highway 12/88 <br /> Descril�!�any on-site or off-site sources of light of glare(e.g.parking lot lighting,or reflective materials used): <br /> small commercial center adjacent to site <br /> Descrille any on-site or off-site source of odor(e.g.agricultural wastes): <br /> None <br /> DescrilJ�any displacement of people that will be caused by the project(e.g.numbers of people,housing units): <br /> None <br /> 1-7 <br /> �,AUTHORIZATION SIGNATURES <br /> .1p ,ONLY HE OWNER OF THE PROPERTY ORAN AUTH.ORIZED.AGENT MAY.Fi 0" <br /> 1,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 fu rth r certify,under penalty of perjury,that I am(check one): <br /> 0,1 Legal property owner(owner includes partner,trustee,grantor,or corporate officer)of the property(s)involved in this 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 /> ii authorized to file on their behalf.,and that the foregoing application statements are true and correct. <br /> Print N��me: Steven E.Pechin Signature: Date: <br /> Print Name: Signature: Date: <br /> Print N�me: Signature: Date: <br /> Print Name: Signature: Date: <br /> Print N me: Signature: Date: <br />� <br />| »ommAnnlic"mmFonnsWomsnECmomcmJow Page 5ofS <br />