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PLAN MAP AMENDMENT r: l SAN JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT FILE NUMBER: - - Hazardous Materials:. Describe an hazardous materials/wastes that will be present on-site:: O Other Describe any items of historical or archaeological interest on-site (e.g.cemeteries or structures): r Describe any on-site or off-site sources of noise or vibration(e.g.freeway noise,heavy equipment,etc.): lLOMF_ Describe any on-site or off-site sources of light of glare(e.g.parking lot lighting,or reflective materials used): dmF_- Describe any on-site or off-site source of odor(e.g.agricultural wastes): "ow Describe any displacement of people that will be caused by the project(e.g.numbers of people,housing units): ext Fs 1 O (LL 89- ,EMOL.t 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 forqqoina Wplicaton statements are true and correct. Print Name: L�"tv- Signature: Date: D Print Name: Signature: Date: Print Name: Signature: Date: Print Name: Signature: Date: Print Name: Signature: Date: F:\DEVSVC\Planning Application For n\ Page 7 of 7 Plan Application AmendmenLcIm.(Revised 04-25-05)