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4u " APPLICATION - ZONE RECLASSIFICATION <br /> c a <br /> SAN JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT <br /> FILE NO: ZR- <br /> Other <br /> Describ any items of historical or archaeological interest on-site e. .cemeteries or structures): <br /> K <br /> Describe any on-site or off-site sources of noise or vibration e. .freeway noise,heavy equipment,etc. : <br /> De's'cribe an on-site or off-site sources of light of glare e. .parkinglot lighting,or reflective materials used): <br /> N la <br /> Describe pny on-site or off-site source of odor e. .agricultural wastes): <br /> N - <br /> Descri any displacement of people that will be caused by the promect 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 /> further certify, under penalty of perjury,that I am(check one): <br /> dLegal 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 th ap licat n of the property's involved in this application and have been <br /> authorized to file on their behalf.,and that the foregoin ap lica'on statements are true and correct. <br /> Print Name:c�R�l)ES TC//V 67 SI gature: Date: —r 8 <br /> Print Name: Signature: Date: <br /> Print Name: Signature: Date: <br /> Print Name: Signature: Date: <br /> Print Name: Signature: Date: <br /> POEMMPlanning Application Fa"MZONE RECLASSIFICATION Page 5 of 5 <br /> (Rev.05-11-09) <br />