Laserfiche WebLink
ti� z <br /> APPLICA ■ ION - REVISIONS OF A ■ ROVED ACTIONS <br /> SAN JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT <br /> ....................:.....::�::'---•-".......,....,.:... , ra�:r-t*:.,+::.•.o:�-....<-a.,g::.a-r:�n::�c.:-:hsxok�.Sc3"E;:>:. :.<`��.�s.,�...:'•.2�xi::,;��:i;-;:�:i�:a::•;::�.- <br /> �y�, <br /> .r i:t5i[?:ji <br /> ....,.. ....:.. .. \.rS., .k 4 �.;g ..,.. yy�� <br /> ?:.2.`L�4{:�`.,;;4•.@����.' {• v,:w3.�u,.-,2`.$.y:U:yS:?`=:`.•n%y�:':?�i::�.':{.::i`:::::t:�k:^:.,;ti.;;;.. `v.M� IL.AiK.'H�.. <br /> Name: L Name: <br /> -Address- ! /V yw' s `v Address: <br /> Phone ON <br /> t. yy <br /> E1� <br /> -n... ... .r.......- <br /> Revision to: �� - Cnnditionts of Approval <br /> Nis No: <br /> 1. <br /> Description of propsed Revisions: ir��.S /='�•'I / /�'C- 1(� S %r� <br /> �. State the facts showing the changes in circumstances which make the subject conditions no longer aro riate or necessary, <br /> i <br /> AUT ON.SIGNATURES <br /> 'ONLY.THE OUVIVEFt QF THE:IPRORERTY.;QR AN.AUTHf]RIZED'AGENT..MAYL*ILI AN APPLICATION. <br /> i, the Owner/Agent agree,to defend, indemnity,and hold harmless the County and its agents,officers and <br /> employees from any claim, action or proceeding against the Owner/Agent's project. <br /> 1, further, certify under penalty of perjury that I am (check one): <br /> j Legal property owner(owner includes partner,trustee,trustor, or corporate officer)of the <br /> property(s) involved in this application,or <br /> 0 Legal agent(attach proof of the owner's consent to the application of the property's <br /> involved in this application and have been authorized to file on their behalf., and that the <br /> foregoing application statements are true and correct. <br /> Print Name: j�° 7F/ Signature: I/,� `i �^ Date: <br /> Signature: Date.Name: <br /> ae. ..�v__. <br /> - Print Name: 'Signature: Date: <br /> �w <br /> L Print Name: Signature: Date: <br /> 1 <br /> I _o_ <br /> llfr 4 <br /> y <br /> I • <br /> .1 <br />