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I �'y °-= PLAN MAP AMENDMENT 4 SAN JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT PILE NUMBER: 4�Crot+% tiazardvc;Is Materla[s Describe any hazardous materials/wastes that will be present on-site:: None s � � -. a ,-. Y... s �`. �� -a�s.fz�c� � y -�•K .�, -s x- s mx+"��`srx x'� s �,,�-'�r�� '°;; s�� '��'r ,�—a�-,�+� _� �s� -��r .,'7�, ^+a*.,,..yb-.. » .,. .--ter....., a z- sk;- .,.. .�,>-:• Describe any items of historical or archaeolo cjical interest on-site(e.g.cemeteries or structures): Describe any on-site or off-site sources of noise or vibration(e.g.freeway noise, heavy equipment,etc- i is near Highway 4 and Escalon Bellota Road. Describe any on-site or off-site sources of light of glare e. .parWng lot lighting,or reflective materials used): On site lighting (lo Describe any on-site or off-site source of odor(e.g.agricultural wastes): None Describe any displacement of people that wilt be caused by the project(e.g.numbers of people,housing units): 5 ' AUTHQRIZAWN Std!jA THE:OW IN OF THE PROPERTY �R AN AUTHORIZED:AGENT MAYKFILE 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 Owner/Agent's project. I,further,certify 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(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. / Print Name: 1 l l r 1pignature: Date: ;? Print Name: Signature: Date: Print Name: Signature: Date: Print Name: Signature: Date: Print Name: Signature: Date: FADEVSVC�Plarning Application Formsl Page 8 of 8