SU0005182 - Laserfiche WebLink

Home Browse Search

PLAN VAP AMENDMENT :< SAN JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT . FILE NUMBER: - - ff••a�e'i� rdofiS,Ma1€elr�sl1 �� ,Pi�'r� .z Describe any hazardous materials/Wastes that will be present.on-site::✓ A-[ o P r.: ?, r:.-»�� F.k..,,.�.:' �. x.• -.x ,. .�;.,, .'U,�.:�..�;� � ,:�:,..,..� -,. ;..:.,.4.4�as`�.i�_ .� .:r.4u„� �, Nw.5<. .: a- t r.. sa Describe any items of historical or archaeological interest on-site(e.g.cemeteries or structures): /�-- I Describe-any on-site or off-site sources of noise or vibration(e.g.freeway noise,heavy equipment,etc.): r, , 01r" Describe any on-site or off-site sources of light of glare(e.g.parking lot lighting,or reflective materials used): Describe any on-site or off-site source of odor(e.g. agricultural wastes): IA- Describe , any displacement of people that will be caused by the project(e.g.numbers of people,housing units): /L/y/4- AUTHORIZATION:SIGNATURES ONLY THE OWNER OF THE PROPERTY,OR;AN AUTHORIZED AGENT MAY FILE-AN APPLICATION. 1, 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, grant r, corporate officer) of the property(s) involved in this application, or ❑ Legal agent(attach proof of the owner's consent to the ap tion of the property's involved in this application and have been authorized to file on their behalf., and that the f oin application statements are true and correct. Print Name: S7,rf ve Z, FA e Signature: Date: Z a� Print Name: Signature: bate: Print Name: Signature: Date: Print Name: Signature: Date: Print Name; Signature: Date: F:0E-V5VGXPlanningApplication Forms% Page 7 of 7 Plan Application Amendment.doc.(Revised 6-03-04)