Laserfiche WebLink
�oPc°c. PLAN MAP AMENDMENT <br /> I { SAN JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT <br /> <i�aa <br /> �P FILE NUMBER: - - <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 /> Offsite existing street lights. <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 /> i 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 /> 1, 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 /> this application, or <br /> I <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 fZe0oinq application <br /> statements are true and orre t. <br /> i Print Name: i�4 l Z -✓ia��s +n T_tt Signature: �-°�-� Date: th d <br /> �c.� L � <br /> Print Name: ' Signature: Date: <br /> r Print Name:6� Signature: Date: <br /> Print Name: Signature: Date: <br /> Print Name: Signature: Date: <br /> FADEVSMPlanning Application Forms\ Page 7 of 7 <br /> Pfan Application Amendment.doc.(Revised 05-11-49 <br /> 3 <br />