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DocuSign Envelope ID: E3D5593F-5l3C1-4D54-972C- )1746EA12 <br /> q"�tN <br /> ° cq PLAN MAP AMENDMENT <br /> j SAN JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT <br /> �c•., - FILE NUMBER: - - <br /> �a<.JFo��`� <br /> Hazardous Materials <br /> Describe any hazardous materials/wastes that will be present on-site:: <br /> Existing Fuel tanks <br /> Other <br /> Describe any items of historical or archaeological interest on-site(e.g. cemeteries or structures): <br /> None <br /> Describe any on-site or off-site sources of noise or vibration(e.g.freeway noise,heavy equipment,etc.): <br /> Truck traffic-the site is next to Interstate 5 and existing traffic noise. <br /> Describe any on-site or off-site sources of light of glare(e.g. parking lot lighting, or reflective materials used): <br /> There will be shielded parking lot lighting within the site. <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 FILE AN APPLICATION. <br /> I, the Owner/Agent 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 /> I, further, certify under penalty of perjury that I am (check one): <br /> ❑x Legal property owner(owner includes partner, trustee, grantor, or corporate officer) of the property(s) involved in <br /> this application, or <br /> ❑ Legal 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 forego0q6tipplipatign statements are true and correct. <br /> Print Name: Ranjit Gill Signature: �aNJaU Date:10/04/2021 <br /> 6C786E86B6524B9 <br /> o—Signed Dy: <br /> . <br /> Print Name: Sukhvinderpal Gill Signature: Sul 6t ,Aabglj : 10/04/2021 <br /> (�D—Sig-d by: 6C786E86B6524B9.. <br /> Print Name: Ravinder S Dhillon Signature: `1 Date: 10/04/9091 <br /> OF66C660082A463... eg igne 6� <br /> Print Name: _ Dallit Dhi Ilo n Signature: k d�,ho-� Date: 10/04/2021 <br /> OF66C660082A463. , <br /> Print Name: Signature: Date: <br /> F:\DEVSVC\Planning Application Forms\ Page 7 of 7 <br /> Plan Application Amendment.doc.(Revised 05-11-09 <br />