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i QAq`'n. PLAN MAP AMENDMENT SAN JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT �fFo"t'�P FILE NUMBER: - - y „Yr.r 7 s.. 5. -� a' P. k�k.-X ` .x 'c'at— ?' S. a r d.�, z FleZatcMaltBtials 4...,..:w ,;. 'z",..::r ,�„�'xt_.*�:.n .� .'�. .t,:..,"5. :i.,,. ,w.,. „ ...N �,.. - ...�.i . Describe any hazardous matedaistwastes that will be present on-site:: . N NONE I i Describe any items of historical or archaeological interest on-site(e.g.cemeteries or structures): NONE Describe-any on-site.or off-site sources of noise or.vibration(e.g.,freeway noise,heavy equipment,etc.): FREEWAY NOISE 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. 1, 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 OwneOAgent'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 correct. Print Name: KANWARTTT ICE FY Signature Date: 01/05/06 Print Name: HOWARD L. SEJ-G� Iy , Signature: Date: Print Name: Signature: Date: Print Name: i Signature: Date: Print Name: Signature: Date: 1 F:IDEVSVC\Planning Application FormM Page 7 of 7 Plan Application Amendment,doc.(Revised 06.03-05)