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i PLAN MAP AMENDMENT <br /> SAN JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT <br /> FILE NUMBER: <br /> ''1�eta••:. <br /> Hazardous Materials <br /> Describe an hazardous materials/wastes that will be present on-site:; <br /> None <br /> Other <br /> Describe any items of historical or archaeological Interest on-site(e.g.cemeteries or structures): <br /> nothina known of <br /> Describe any on-site or off-site sources of noise or vibration(e.g.freeway noise,heavy equipment,etc,): <br /> E Main relementary-school <br /> Describe any on-site or offsite sources of fight of glare(e.g.parking lot lighting,or reflective materials used), <br /> None <br /> Describe any on-site or off-site source of odor(e.g.agricultural wastes): <br /> None <br /> Describe any displacement of people that will be caused by the project(e,g.numbers of people, housing units)• <br /> None <br /> AUTHORIZATION SIGNATURES <br /> ONLY THE OWNER OF THE PROPERTY OR AN AUTHORIZED AGENT MAY T=ILE AN APPLICATION. <br /> I, the Owne0Agent 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 OwnerlAgent's project. <br /> I, 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 /> 13 Legal agent(attach proof of the owner's consent to the application of the property's involved in this applic tion nd <br /> have been authorized to file on their behalf., and that the oin a Iicat' .n tater ents are true a c tract <br /> Print Name: Ernie Vast) __ Signature: 1- Date: <br /> Print Name: Signature: Date: <br /> Print Name: Signature: Date: <br /> Print Name: Signature: Date: <br /> Print Name: Signature: Date: <br /> IPMEVSVC1Planning Application Farmsl Page 7 of 7 <br /> Plan Application Amendmant.doc-(Rsviaed 05-11-09 <br />