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° NE ° PLAN SVI A P A M E N D IVB E �1 T �. � • .oG SAN JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT . . �P FILE NUMBER : - 9 �1polt Hazardous Materials Describe any hazardous materials/wastes that will be present on - site : : None Other Describe any items of historical or archaeological interest on -site ( e . g . cemeteries or structures ) : nothing known of Describe any on -site or off-site sources of noise or vibration ( e . g . freeway noise , heavy equipment , etc . ) : E Main Street and elementary school Describe any on -site or off-site sources of light of glare ( e . g . parking lot lighting , or reflective materials used ) : None Describe any on -site or off-site source of odor ( e . g . agricultural wastes ) : None Describe any displacement of people that will be caused by the project ( e . g . numbers of people , housing units ) : None 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 County arising from 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 Legal agent ( attach proof of the owner' s consent to the application of the property' s involved in this application and have been authorized to file on their behalf . , and that the foregoing application statements are true and c rrect . I Print Name : Ernie Vasti Signature : V'vN�� 1Y Date : Print Name : Signature : Date : Print Name : Signature : Date : Print Name : Signature : Date : Print Name : Signature : Date : F : \DEVSVC\Planning Application Forms\ Page 7 of 7 Plan Application Amendment . doc . ( Revised 05 - 11 -09