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9 <br /> r <br /> PLAN MAP AMENDMENT <br /> SAN JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT <br /> a' <br /> FILENUMBER: - <br /> Hazardous Materials <br /> Describe any hazardous materials/wastes that will be present on-site:: <br /> Small quantities of fertilizer and herbicides for landscape purposes. <br /> Other <br /> Describe any items of historical or archaeological interest on-site(e.g.cemeteries or structures): None <br /> Describe any on-site or off-site sources of noise or vibration(e.g.freeway noise,heavy equipment,etc.): <br /> G Cemetery is expected to have approximately 15 burials a month. Each burial requires 1-1 112 hrs.of backhoe and small tractor usage. <br /> Describe any on-site or off-site sources of light of glare(e.g.parking lot lighting,or reflective materials used): <br /> Future site lighting will illuminate building and gate entry. <br /> Describe any on-site or off-site source of odor(e.g.agricultural wastes): <br /> Small quantities of fertilizer and herbicides for landscape purposes.- <br /> Describe <br /> u ses.-Describe any displacement of people that will be caused by the project(e.g.numbers of people,housing units): None <br /> i <br /> AUTHORIZATION SIGNATURES <br /> ONLY THE OWNER'OF THE PROPERTY-OR AN AUTHORIZED AGENT MAY FILE AN APPLICATION. <br /> I, the OwnerlAgent agree, to defend, indemnify, and hold harmless the County and its agents, officers and employees <br /> from any claim, action or proceeding against the County arising from the Owner/Agent's project. <br /> t, 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 /> ELegal 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 Name: Axmy , Signature: Date: Z z / <br /> Print Name: Signature: Date: <br /> Print Name: Signature: Date: <br /> Print Name: Signature: Date: <br /> Print Name: Signature: Date: <br /> RIDEVSVOPlanning Appiicadon Fomisl Page 7 of 7 I <br /> Plan Application Amendmmtdoc.(Revised 05-11-09 <br /> f <br /> r <br />