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YOR�.•t c •s APPLICATION ZONE,. 4ECLASSIFICATI <br /> W- `` SAN JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT:. <br /> FILE NO: ZR- <br /> 1. <br /> -;.s? <br /> '.fl.escribe an items of historical or-archaeolii ical inle.rest,on site e. :,cemetenes oestructrares <br /> Describe any on-site or off-site sources of.noise or vibration (e.g.freeway noise hea. e' ui ment.,.etc <br /> I <br /> Describescribe any on-site or o#-site sources of Ir ht <br /> f tare e. arkinlot lighting, reflective <br /> materialsused : <br /> Describe <br /> i <br /> any on-site or off-site source of odor(e.g. agricultural wastes): <br /> i <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,indemnity,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 /> 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 /> Print Name: � '�'"� Signature: Date9 <br /> Print Name: _ZD k t'i T9-1 eJ - _ Signatur hate: /D <br /> Print Name: Signature: Date: <br /> Print Name: Signature: Date: <br /> s <br /> Print Name: Signature: Date: <br /> { FDEVSVSTIanning Application Forms\ZONE RECLASSIFICATION Page 5 of 5 <br /> (Rev.12-07-06) <br /> 4 <br />