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I. 2004 2:23 PM BENNE?? DEV No. 155! I. L <br /> 4 r. APPLICATION -ZONrRECLASSIFICATION <br /> k,. <br /> SAN JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT <br /> FILE NO: ZR- <br /> Describe any items of hisbrical or archaeological interest on-alta(e.g cemeteries or structures): None that the applicant is <br /> aware of. <br /> Describe any onjifle or off-site sources of noise or vibration e. .freeway noise heavy equipment,ate.: Boise impacts caused b <br /> traffic activities on East Main street, <br /> Describe any on-site oT off-sik off- souposs of I` tof alare a. .parking lot lighting,or refleatiVe materials u : Bene that the applicant <br /> is aware of. <br /> pen n orof-sib 30uroeof odor tea. cultural : Noce that the applicant is aware of. <br /> Describe any displacement Of pwle that wtA be caused by the project e.g,numbers of peoplet housing unitel. None that the <br /> applicant is aware of. <br /> } t a <br /> 1,t;a 0wrovA,gent agree,to defend:indernnify,and hold harmless the County and its agents,officers and omipioyces from any claim, <br /> taction or prw,; .ding 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'his appfeation, <br /> or <br /> 13 Legal agent(attach proof of the ownet'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 /> PrlmName: �GOVI�crSlno Signature: Date: �a —y <br /> Ptint Name: Slgnatwe: Date: <br /> Prim Name: Signature: Date? <br /> Print Name: Signet"; Dam: <br /> Print Name: Signature: Date: <br /> FiDEV5wblPIDMAp Appliratidn Foms1ZONE RECLA951F:CATION Page 5 of 5 <br /> IRev.6-02-061 <br />