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APPLICATION - ZONE RECLASSIFICATION <br /> 2' .Z <br /> SAN JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT <br /> �q`' o*a;P• FILE NO: ZR <br /> Other <br /> Describe any items of historical or archaeological interest on-site(e.g.cemeteries or structures): <br /> None <br /> Describe any on-site or off-site sources of noise or vibration(e.g.freeway noise,heavy equipment,etc.): <br /> See Attachment A <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 /> See Attachment A <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 Owner/Agent's project. <br /> I further certify,under penalty of perjury,that I am(check one): <br /> C Legal property owner(owner includes partner,trustee,grantor,or corporate officer)of the property(s)involved in this application, <br /> 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: ��� " , u Y 1 µ Signature: / �� 1 Date: � / <br /> Print Name: Signature: Date: <br /> Print Name: Signature: Date: <br /> Print Name: Signature: Date: <br /> Print Name: Signature: Date: <br /> F:\DEVSVS\Planning Application Forms\ZONE RECLASSIFICATION Page 5 of 5 <br /> (Rev.6-02-04) <br />