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_ A0.Ut _ PLAN MAP AMENDMENT <br /> SAN JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT <br /> FILE NUMBER: - - <br /> • IFpiR� <br /> Hazardous Materials <br /> Describe any hazardous materialstwastes that will be present on-site:: <br /> NONE ANTICIPATED OTHER THAN REGULAR CONSTRUCTION MATERIALS <br /> Other <br /> Describe any items of historical or archaeological interest on-site(e.g.cemeteries or structures): <br /> NO HISTORICAL OR ARCHAEOLOGICAL INTERESTS ON SITE <br /> Describe any on-site or off-site sources of noise or vibration(e.g.freeway noise,heavy equipment,etc.): <br /> NONE OTHER THAN CONSTRUCTION EQUIPMENT DURING CONSTRUCTION ACTIVITIES <br /> Describe any on-site or off-site sources of light of glare(e.g.parking lot lighting,or reflective materials used): <br /> SIGN OF PROPOSED PROJECT WILL CAUSE ALL LIGHTING TO BE ILLUMINATED ONLY ON THE PROJECT AREA. <br /> NO GLARE AFFECTING SURROUNDING PROPERTIES <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,housing units): <br /> NONE <br /> AUTHORIZATION SIGNATURES <br /> ONLY THE OWNER OF THE PROPERTY OR AN AUTHORIZED AGENT MAY FILE AN APPLICATION. <br /> [from <br /> the Owner/Agent agree, to defend, indemnify, and hold harmless the County and its agents, officers and employees <br /> any claim,action or proceeding against the County arising from the Owner/Agent's project. <br /> 1,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 <br /> this application,or <br /> ❑ Legal agent(attach proof of the owner's consent to the application of the property's involved in this application and <br /> have been authorized to file on their behalf.,and that the foregoing application statements are true and correct. <br /> Print Name: DAVID RAJKOVICH Signature: \�( Date: 1/30114 <br /> Print Name: Signature: Date: <br /> Print Name: Signature: Date: <br /> Print Name: Signature: Date: <br /> Print Name: Signature: Date: <br /> FADEVSVC\Planning Application FortnsN Page 7 of 7 <br /> Plan Appkation Amendmentdoc.(Revised 05-11-09 <br />