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PLAN MAP AMENDMENT <br /> i SAN JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT <br /> FILE NUMBER: - <br /> %�(7R <br /> Hazardous.Materials <br /> Describe any hazardous materials/wastes that will be present on-site:: <br /> I <br /> .:.Other <br /> Describe any items of historical or archaeological interest on-site(e.g.cemeteries or structures <br /> Describe any on-site or off-site sources of noise or vibration e. .freeway noise heavy equipment,etc. : <br /> Describe any on-site or off-site sources of light of glare e. .parking lot lighting,or reflective materials used): <br /> Describe any on-site or off-site source of odor e. .agricultural wastes): <br /> Describe any displacement of people that will be caused by the project e. .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 from <br /> 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 /> XLegal property owner(owner includes partner, trustee,grantor, or corporate officer) of the property(s) involved in this <br /> application,or <br /> ❑ Legal agent(attach proof of the owner's consent to the application of the prope ' Involved in this application and <br /> have been authorized to file on their behalf.,and that the forpgoing applic ' statements are true and correct. <br /> Print Name: Sent Hoggan Signature: Date: 8 Aug 2005 <br /> Print Name: Signature: Date: <br /> Print Name: Signature: Date: <br /> Print Name: Signature: Date: <br /> Print Name: Si nature: Date: <br /> F.IDEVSMftnning Application Forms\ Page 8 of 8 <br /> General Plan Amens n entbm.(Revised 3-5-04) <br />