SU0005929 - Laserfiche WebLink

Home Browse Search

=SANJOAQUIN PLAN MAP AMENDMENT COUNTY COMMUNITY DEVELOPMENT DEPARTMENT FILE NUMBER: - _ ,HazardousMate�als Describe an hazardous materials/wastes that will be resent on-site:: Other Describe any items of historical or archaeological interest on-site (e.g. cemeteries or structures): O Describe any on-site or off-site sources of noise or vibration (e.g.freeway noise,heavy equipment,etc.): 9010E iF_ Describe any on-site or off-site sources of light of glare(e.g. parking lot lighting, or reflective materials used): C7 Ml — Describe any on-site or off-site source of odor(e.g. agricultural wastes): Qow Describe any displacement of people that will be caused by the project(e.g. numbers of people, housing units): of tq- 1C-xtS-Mt lCt t -5F- 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 to oin licat' n statements are true and correct. Print Name: L t, tv— �A�I'-et{g IG Signature: Date: D Print Name: Signature: / Date: Print Name: Signature: Date: Print Name: Signature: Date: Print Name: Signature: Date: F:\DEVSVC\Planning Application Forms\ Page 7 of 7 Plan Applicabon Amendment.doc.(Revised 04-25-05)