Laserfiche WebLink
1 <br /> PLAN MAP AMENDMENT <br /> t SAN JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT <br /> • '=a_ 's�!�. FILE NUMBER: - - <br /> • �FORa <br /> Hazardous Materials <br /> Describe any hazardous materialstwastes that will be ent 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 /> 1, the Owner/Agent agree, to defend, indemnify,and hold harmless the County and its agents, officers and employees <br /> from any claim,action or proceeding against the County arising from the Owner/Agent's project. <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 <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: \ tr Date:M0114 <br /> Print Name: Signature: Date: <br /> Print Name: Signature: Date: <br /> Print Name: Signature: Date: <br /> Print Name: Signature: Date: <br /> F:\DEVSVOPlanning Application Forms\ Page 7 of 7 <br /> Plan Application Amendmentdcc.(Revised'05-11-09 <br />