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s#' PLA"AP AMENDMIE14T <br /> t SAN JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT <br /> FILE NUMBER: - - <br /> �jfia <br /> Hazardous Materials <br /> I Describe any hazardous materials/wastes that will be present on-site:: <br /> Other <br /> Describe any items of historical or archaeological interest on-site(e.g.cemeteries or structures): <br /> pc <br /> Describe any on-site or off-site sources of <br /> noise or vibration (e.g,freeway noise, heavy equipment, etc.): <br /> Describe any on-site or off-site sources of light of glare(e.g. parking lot lighting,or reflective materials used): <br /> Describe any on-site or off-site source of odor(e.g.agricultural wastes): <br /> Describe any displacement of people that will be caused by the project(e.g. numbers of people, housing units): <br /> lu` l <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 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 true and correct. <br /> Print Nam, pA9 1 2 (11 11 . &FRJ2;i* Signature: t Q� <br /> c <br /> Print Name Signature: Date: <br /> 0_5; <br /> Print Name: Signature: U Date: <br /> Print Name: Signature: Date: <br /> Print Name: Signature: Date: <br /> F:ID6VSVC%Planning Application Formsl Page 7 of 7 <br /> Plan Application Amendment.doc.(Revised 11-05-07 <br />