Laserfiche WebLink
y a C) C7 <br /> �aAC1 iJ f H - <br /> PLAN MAP AMENDMENT <br /> SAN JOAQUIN COUNTY COMMUNITY DEVELOPMENTOPMENT DEPARTMENT <br /> FILE NUMBER: - <br /> Describe an hazardous materials wastes that will be resent o Hazardous <br /> Materials <br /> Other <br /> Describe any items of historical or archaeological interest on-site(e-g.cemeteries or structures): <br /> d <br /> I <br /> Describe any on-site or off-site sources of noise or vibration (e.g.freeway noise, heavy equipment, etc.): <br /> Describe any on-site or off-site sources of light of glare(e.g.parking lot lighting, or reflective materials used): <br /> Describe any on-site or off-site source of odor(e.g.agricultural wastes): <br /> Describe any displacement of people that will be caused by the project(e.g. numbers of people,housing units): <br /> AUTHORIZATION SIGNATURES <br /> ONLY THE OWNER OF THE PROPERTY OR AN AUTHORIZED AGENT MAY FILE AN APPLICATION. <br /> I, 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 OwnerlAgent's project. <br /> I, further, certify under penalty of perjury that I am(check one): <br /> YLegal property owner(owner includes partner, trustee, grantor, or corporate officer)of the property(s)ert <br /> this application, or p p y(s)involved in <br /> ❑ t egal agent(attach proof of the owner's consent to the application of the property's involved in this application <br /> have been authorized to file on their behalf., and that the foregoing a licati t <br /> Print Name: tements are true a d correct. <br /> �� <br /> s <br /> Signature: �,(,, <br /> Print Name p/tt! Date: <br /> Signature: <br /> Print Name: Date: <br /> Signature: <br /> Print Name: Date: <br /> - Signature: <br /> Print Name: Date: <br /> Si nature: <br /> Date: <br /> FMEVSvc%Planning Application Formsl <br /> Plan Application Amendment,doc.(Revised 05-11-09 gage 7 of 7 <br />