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a.� PLAN L.AP AMEPiDWENT X SAN JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT p FILE NUMBER: - L%F OP� - —J Hazardous Materials - Describe any hazardous materials/wastes that will he present on-site:: NONT Other Describe any items of historical or archaeological interest on-site(e.g.cemeteries or structures): NOIQE Describe any on-site or off-site sources of noise or vibration (e.g.freeway noise, heavy equipment,etc.): TIS PROPERTY IS ENff�IEDIATELY ADJACENT TO HIGHW 99 ON THE WEST SIDE DI EDIATE[Y ADJACENT TO OFFP" Describe any on-site or off-site sources of light of glare(e.g. parking lot lighting,or reflective materials used): ONCE DEVELOPED THERE WILL BE ON-SITE LIGHTING FOR PARKI14G AND LIGHT]TTG FOR EKISTI14G USES LII = TO THE SITE ITSELF Describe any on-site or off-site source of odor(e.g. agricultural wastes): Describe any displacement of people that will be caused by the project(e.g. numbers of people, housing units): BONE 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 P4 Legal agent (attach proof of the owner's consent to the application of the p perty's involved in this application and have been authorized to file on their behalf., and thaO helpi-pgoing qp4ic0fiqpstatements are true and c rrect Print Name: HO('LARD L. SELIG,AN Signatu Date: Print Name: Signature: Date: Print Name: Signature: Date: Print Name: Signature: Date: Print Name: Signature: Date: F\DEVSVC1Planning Application Fonnsl Page 7 of 7 Plan Application Amendment.cm.(Revised 12-07-06)