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4 <br /> PLAN MAP AMENDMENT <br /> SAN JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT <br /> FILE NUMBER: - <br /> r_r' a i <br /> Hazardous Materials <br /> Describe any hazardous materials/wastes that will be present on-site:. <br /> NONE <br /> Other <br /> Describe any items of historical or archaeological interest on-site (e.g. cemeteries or structures): <br /> NONE <br /> Describe any on-site or off-site sources of noise or vibration (e.g. freeway noise. heavy equipment, etc.): <br /> NONE <br /> Describe any on-site or off-site sources of light of glare(e.g. parking lot lighting, or reflective materials used): <br /> NONE <br /> Describe any on-site or off-site source of odor(e.g. agricultural wastes): <br /> NONE <br /> Describe any displacement of people that will be caused by the project(e.g. numbers of people, housing units): <br /> NONE <br /> AUTHORIZATION SIGNATURES <br /> rence <br /> HE OWNER OF THE PROPERTY OR AN AUTHORIZED AGENT MAY FILE AN APPLICATION. <br /> er/Agent agree, to defend, indemnify, and hold harmless the County and its agents, officers and employees <br /> laim, action or proceeding against the County arising from the Owner/Agent's project. <br /> certify under penalty of perjury that I am (check one): <br /> property owner (owner includes partner, trustee, grantor, or corporate officer) of the property(s) involved in <br /> pplication, or <br /> agent (attach proof of the owner's consent to the application of the property's involved in this application and <br /> been authorized to file on their behalf., and that the foregoir}q application statements are true and correct. <br /> ! Print Name: R&R SCHATZ PROPERTIES Signature: Date: <br /> Print Name: RnnNEY SCHATZSignature:, c" Date: S y�3 Z/4 <br /> Print Name: R ',TTA SCHATZ Signature: - Date: -z� <br /> Print Name: Signature: Date: <br /> Print Name: <br /> Si nature: Date: <br /> F.\DEVS=Planning Application Forms\ Page i of 7 <br /> Plan Application Amendment.doc.(Revised 05-11-09 <br />