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- • � t y� ° PLAN MAP AMENDMENT SAN JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT FILE NUMBER: - - Hazardous Materials Describe an hazardous materialslwastes that will be resent on-site:: NONE Other 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.): NEARBY INTERSTATE 580 AND TRUCK TRAFFIC. Describe any on-site or off-site sources of light of glare(e.g.parking lot lighting,or reflective materials used): LIGHHTING PROVIDED THROUGHOUTZITE FOR SECURITY. 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 I 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 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 ap lication of the property's involved in this application and have been authorized to file on their behalf., and that th�Tle in a c ion statements are true and correct. Print Name: Am �SS Signature: Date: _2_3 Print Name: Signature: Date: Print Name: Signature: Date: Print Name: Signature: Date: Print Name: Signature: Date: F:4DEVSVCIPlanning Apphcatlon Formsl Page 7 of 7 Plan Application Amendment.doc {Revised 08-27-07 I