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DocuSign Envelope ID : 55CF8235 - 1D4A-4FBA- 9DD2 - F1CAB199388E oc uit p rr p p n 'I � p p I� p � p ��-� � � i=-' L_ 0 �� ,'�, �� Il �J �'I `—' �� u V L Hi LS lh l �: c ) fl I U G� ;-',\ II 0 II '�' I SAN JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT ad too FILE NO : ZR - " eo see . LL 0049 # 00 * 0 Other —Describe_any items of historical or archaeological interest on -site e . g . cemeteries or structures ) : None Describe any on - site or off - site sources of noise or vibration ( e . g . freeway noise , heavy equipment , etc . : Project site is 3 /4 of a mile from railroad tracks and 1 mile from California State Highway Route 120 Describe any on - site or off - site sources of light of glare ( e . g . parkinglot lighting , or reflective materials used ) : None Describe any on - site or off - site source of odor e . g . agricultural wastes ) : None Describe any displacement of people that will be caused by the project ( e . g . numbers of people , housing units ) : None AUTHORIZATION SIGNATURES ONLY THE OWNER OF THE PROPERTY OR AN AUTHORIZED AGENT MAY FILE AN APPLICATION . I , the Owner/Agent agree , to defend , indemnify , 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 certify , under penalty of perjury , that I am ( check one ) . ❑X 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 property ' s involved in this application and have been authorized to file on their behalf . , and that the foregoing application statements are true and correct . DocuSigned by: Brittany Lafferty �j ��le 5 / 11 / 2021 Print Name : Signature : ~7J +It Date : — D92F6CD1 DECB492 . . . Print Name : Signature : Date : Print Name : Signature : Date . Print Name : Signature : Date : Print Name : Signature : Date : F :\ DEVSVS\Planning Application Fornis\ZONE RECLASSIFICATION Page 5 of 5 ( Rev . 05 - 11 - 09 )