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i PLAN MAP AMENDMENT SAN JOAQUIN COUNTY COMMUNil Y DEVELOPMENT DEPARTMENT FILE NUMBER: ''1 � eta ••:. Hazardous Materials Describe an hazardous materials/wastes that will be present on-site:; None Other Describe any items of historical or archaeological Interest on-site (e.g. cemeteries or structures): nothina known of Describe any on-site or off-site sources of noise or vibration (e.g. freeway noise, heavy equipment, etc,): E Main relementary-school Describe any on-site or offsite sources of fight 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 T=ILE AN APPLICATION. I, the Owne0Agent agree, to defend, indemnify, and hold harmless the County and its agents, officers and employees from any claim, action or proceeding against the County arising from the OwnerlAgent'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 13 Legal agent (attach proof of the owner's consent to the application of the property's involved in this applic tion nd have been authorized to file on their behalf., and that the oin a Ilcat' . n tater ents are true a c tract ,1 Print Name: Ernie Vast) _ _ Signature: 1- Date: Print Name: Signature: Date: Print Name: Signature: Date: Print Name: Signature: Date: Print Name: -Signature: Date: F:MEVSVclP1annin9 Application Formsl Page 7 of 7 Plan Application Amendmant.doc- (Rsviaed 05-11-09