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p PLAN MAP AMENDMENT SAN JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT i' FILE NUMBER: - C%Fp RNA: Hazardous Materials Describe any hazardous materials/wastes that will be present on-site:: Nnnp Other 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.): None 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 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 foreqoinq application statements are true and correct. Print Name: J e- Signatur Date: Print Name: Signature: Date: Print Name: Signature: Date: Print Name: Signature: Date: Print Name: Si nature: Date: F-DEVSVCIPlanning Application Farms\ Page 7 of 7 Plan Application Amendment.doc.(Revised 12-07-06)