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a.-Al PLAN MAP AMENDMENT SAN JOAQUiN COUNTY COMMUNITY DEVEOf=,MENT DEPARTMENT FILE NUNIBER: - - 9`F Hazardous Materials Describe any hazardous mater4slwastes that will be present on-site:: There are RroRosed leach fields and gas station. 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.): Highway 88 Noise. Noise related to existing vineyards. j Describe any on-site or off-site sources of light of glare(e.g. parking lot lighting,or reflective materials used): r Vehicle lights from Highway 88 traffic. 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): Two housing units will be removed. 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 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: �j '=��/�� i -�H� . natur Date: Print Name: Signature: Date: Print Name: Signature: Date: I Print Name: Signature: Date: Print Name: Signature: Date: ; F:0EVSVC%PIanning Application Form s\ Page 7 of 7 Pian Apptication Amendrnent.doc.{Revised 11-05-07