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PLAN MAP AMENDMENT <br /> SAN JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT <br /> cP FILE NUMBER: - <br /> G%FOAM` <br /> Hazardous Materials <br /> Describe anv hazardous materials/wastes that will be present on-site:: <br /> Other <br /> Describe any items of historical or archaeological interest on-site(e.g.cemeteries or structures): <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 /> Parking Lot Lights <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 Owner/Agent's project. <br /> I,further, certify under penalty of perjury that I am (check one): <br /> Legal property owner(owner includes partner, trustee, grantor, or corporate officer)of the property(s) involved in <br /> his application, or <br /> Legal agent (attach proof of the owner's consent to the application of the property's involved in this application and <br /> have been authorized to file on their behalf., and that the fore oin lication statements are true and correct. <br /> 2Lrlanwar VP e Signature: Date:,1LC L K Signature: �iyi� Date: 21 Signature: Date: <br /> Signature: Dale: <br /> Si nature: Date: <br /> F:\DEVSVOPlanning Application Forms\ Page 7 of 7 <br /> Plan Application Amendment.doc.(Revised 05-11-09 <br />