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�r <br /> -ii 2�. <br /> °R ut ` r APPLICATION - ZOh-" RECLASSIFICATION <br /> SAN JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT <br /> 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 a ui ment, etc.): <br /> None <br /> I <br /> Describe any on-site or off-site sources of light of glare (e.q. parkinglot li htin , or reflective materials used): <br /> Oftsite Existing <br /> Describe any on-site or off-site source of odor(e.g. agricultural wastes): <br /> None <br /> Describe any displacement of people that will be caused by the project(e.g. numbers of people, housin units): <br /> None <br /> AUTHORIZATION SIGNATURES i <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. i <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 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 /> L�L c <br /> Print Name: 7r- •{1-" Signature: „ �.�� Date: <br /> Print Name: �l eViv�, 4j61- Signature_ Date: f((( <br /> Print Name: Signature: Date: ' <br /> Print Name: Signature: Date: <br /> Print Name: Signature: Date: <br /> i <br /> I <br /> I <br /> 4 <br /> f <br /> F:IDEVSVS9lanning Application Forms2ONE RECLASSIFICATION Page 5 of 5 <br /> (Rev.05.11-09) <br />