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°Pg..." APPLICATION - ZONL RECLASSIFICATION <br /> �.•�.• 0 T <br /> N A\ { <br /> SAN JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT <br /> FILE NO: ZR- <br /> OtherDescribe any items of historical or archaeological interest on-site (e.g.cemeteries or structures)7 <br /> Describe any on-site or off-site sources of noise or vibration (e.g.freeway noise, heavy equipment, etc. : <br /> Describe any on-site or off-site sources of li ht of glare (e.g. parkinglot lighting, or reflective materials used): <br /> U <br /> Describe any on-site or off-site source of odor(e.g. agricultural wastes): <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 rtify, under penalty of perjury,that I am (check one): <br /> Lcegal 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: i A—) �'� Signature: 7� K'fIl � 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 />