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, r y <br /> - 01 1 — 27, <br /> APPLICATION - REVISIONS OF APPROVED ACTIONS <br /> SAN JOAQUIN COUNTY COMMUNITY DEVELOPMENT <br /> TMENT <br /> 10 <br /> F i <br /> .r{.. :. x G � ,. <br /> Mlj <br /> x s Name On St S ^Z <br /> Name: ' <br /> Ad rags: 2Z Z S' Address: <br /> rSS - G Zlo9/ G 9 Zoo <br /> Phone: / �9 Phone• Z z <br /> ------ <br /> Revisionto: <br /> Map Canditlonls of Approval <br /> File No:. <br /> 1, Desert tion of proposed Revlstons: <br /> Q� e vi s� encs <br /> The <br /> IS Mler' S rli rh S 4!''e <br /> 6e � rsoh� s �rx e <br /> Pe <br /> `- <br /> 7G� <br /> than es In clrcumsmncss which make a sub ect condltlon s no longer ara rate or neeess <br /> Z; state the facts showingthe <br /> / <br /> h rs 5 l� su�: l e us o <br /> a , <br /> 1 <br /> x <br /> r13UFk•CC7'RlATIN5IGT�l1RTURES ; <br /> 'y a{ f'd'GdSd gyp' $'':'v2 a•ca <br /> KAN <br /> ,rr..:.. <br /> 1,the Owner/Agent agree,to defend,Indemnify,and hold harmless the County and its agents,officers and <br /> employees from any claim,action or proceeding against the OwnerlAgenrs project. <br /> I,further, certify under penalty of perjury that am(check one): <br /> Legal property owner(owner Includes partner,trustee,trustor,or corporate officer)of the <br /> property(s)involved in this application,or <br /> Legal <br /> In thigs appch liroof of the ownees consent to the a pll <br /> cation and have been authorized to flantlan of the o <br /> their behalf..I and that the <br /> foregoing application statements are true nd correct. <br /> r' ( U S signature: / Date: _2/1/40� �J . <br /> Print Name' -� ' <br /> �P.rint-Narne• I - _ __ _ Uala. .,-_� ._ <br /> PrintName: signature: <br /> Print Name: Signature:' Date: <br /> ' Print Name: Signature: Date: <br /> F ` <br /> —2— <br />