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PLAN MAP AMENDMENT <br /> SAN JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT <br /> FILE NUMBER: - - <br /> Hazardous Materials <br /> Describe an hazardous materialstwastes that will be present on-site:: <br /> Dl ESQ (tEL Cid 000 4A41ONSJ <br /> A STE 51V C7/ 4 <br /> Other <br /> Describe any items of historical or archaeological interest on-site(e.g.cemeteries or structures): <br /> Ort(E <br /> Describe any on-site or off-site sources of noise or vibration (e.g.freeway noise, heavy equipment,etc.): <br /> NEQ(/ <br /> Describe any on-site or off-site sources of light of glare(e.g. parking lot lighting,or reflective materials used): <br /> i4 2 EA L-/ f/j/.Vl <br /> Describe any on-site or off-site source of odor(e.g.agricultural wastes): <br /> V, n/E <br /> Describe any displacement of people that will be caused by the project(e.g. numbers of people, housing units): <br /> 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 /> I, further, certify under penalty of perjury that I am (check one): <br /> Q 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 a property's involved in this application and <br /> have been 5utorized to file on their behalf., and that the fore ofapplication statements are true and correct. <br /> Print Name: 1 Signature' Date: <br /> Print Name: yO� CNES,v�jl PE Signature: Date:7- <br /> Print Name: Signature: Date: <br /> Print Name: Signature: Date: <br /> Print Name: Signature: Date: <br /> F:IDEVSMPlanning Application Fonns\ Page 7 of 7 <br /> Plan Application Amendment doc (Revised 05-11-09 <br />