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{« r APPLICATION - ZONE RECLASSIFICATION SAN JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT ;a FILE NO: ZR- Other [None escribe an items of historical or archaeolo Ical interest onsite(e.-g.cemeteries or structures): escribe any on-site or off-site sources of noise or vibration e. .freeway noise,heM equipment,etc. : Cemetery is expected to have approx. 15 burials a month.Each burial requires 1-1 112 hrs.of backhoe and small tractor usage. Describe an on-site or off-site sources of light of glare e, parkinglot lighting,or reflective materials used): Future.site lighting will illuminate building and gate entry. Describe any on-site or off-site source of odor(e.g.agricultural wastes): Small quantities of fertilizer and herbicides for landscape purposes. Describe any displacement of people that wit be caused by the project e. .numbers of people,housing units): None AUTHORIZATION SIGNATURES ONLY THE OW. NSR OF THE PROPERTY OR AN AUTHORIZED AGENT MAY FILE AN APPLICATION. 1,the Owner/Agent agree,to defend,indemnify,and hold harmless the County and its agents,officers and employees from any claim, k action or proceeding against the County arising from the Owner/Agent's project. i I further certify,under penalty of perjury,that I am(check one): i ❑ Legal property owner(owner includes partner,trustee,grantor,or corporate officer)of the property(s)involved in this application,or ❑✓ Legal agent(attach proof of the owner's consent to the application of the properVs involved in this application and have been authorized to file on their behalf.,and that the foregoing application statements are true and correct, i r I Print Name: 6-4/4-Y /4- 4e-Ue Signature: Date: Z/Z 3/1) Print Name: Signature. Date: Print Name: Signature: Date: Print Name: Signature: Date: Print Name: Signature: Date: I' RIDEVSVSIPIanning Appric0on FormOZONE RECLASSIFICATION Page 5 of 5 (Rev.05-1149) t