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I c <br /> P�U1N F <br /> PLAN MAP AMENDMENT <br /> SAN JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT <br /> FILE NUMBER: <br /> Hazardous Materials <br /> Describe anv hazardous mate ria Is/wastes that will be present on-site:: <br /> None <br /> i <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 /> AUTHORIZATION SIGNATURES <br /> ONLY THE OWNER OF THE PROPERTY OR AN AUTHORIZED AGENT MAY FILE AN APPLICATION. <br /> i <br /> I, the Owner/Agent agree, to defend, indemnify, and gold 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 /> this 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 foregoing application statements are <br /> . true and o <br /> Print Name: Signature: Date: <br /> Print Name;I� vc.[ (`r ` h{tj� �'� Signature: Date: <br /> Print Name:p �'y�N �-1 Q'a•C✓ Signature: Date: <br /> Print Name: Signature: Date: <br /> Print Name: Signature: Date: <br /> F:TEV3VC1Planning Application Formsl Page 7 of 7 <br /> Plan Application Amendment.doc.(Revised 05.11-09 <br /> II <br />