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07/17/2013 14:55 FAX APPLICATION - ZONE RECLASSIFICATION SAN JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT FILE NO: ZR• Other Describe any items of historical or archaeological interest on-site 18.9 cemeteries or structures None Describe any on-site or off-sHe sources of noise or vibration Le.g.freeway noise heavy OQWIPMerit,ft-): Interstate 5 Is adjacent to this protect, Agricultural equipment and Roadlsde trefHc noise from boreann roads. I Describe any on-site or off-elle sources of II N of Were(0.9.parking lot II Min i or reflective materials use I Interstate 5 is ad scent to this prolect. Describe an an-site or o1f•slte source of odor e. ricultureI wastes)- A rlcultural chemicals and fertilizers. Describe any displacement o1 Is that will be caused by the project ea numoora of peoRie,housing unite NIA AUTHORIZATION SIGNATURES ONLY THE OWNER OF THE PROPERTY'OR AN AUTHORIZED AGENT MAY PILE AN APPLICATION. I,the OwnedAgent agree,to defend.Indemnity,and hold harmless the County and Its agents, officers and employees from any claim action or proceeding against the County arising from the Owner/Agent's project. I further cortify, under penalty of perjury, that I am(check one)'. ® Legal property owner(owner Includes partner, trustee, grantor, or corporate officer)of the property(s)involved In this application. or ❑ Legal agent(sitsch proof of the Owners consent to the application of the property's vol ed in this application and have been authorized to file on their behalf., and that the foregoing application statements lr and co a '7 �n Print Name! "C / Signature: Dale /•1��/ Print Name: Signature: 'ate: Print Name: Signature: Date Print Name, Signature: Date: Print Name: Signature: Date. F IDEVSVSwlonrnna Appliueon Fo mI%ZONE RECLASSIFICATION Page 5 of 5 (Rev. 0611-09)