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QX - 98 - 002 <br /> APPLICATION - REVI�SINONS OFCOUNTYoMMUNITY APPROVoED <br /> ACTPMENT IONS <br /> SAN JOAY isoDEPATMENT <br /> X'N 1x�r <br /> `?sw b .. pMBt lt•8 .� FL IG'"ANTp191UR•'fl7 Flt.&1G T"5 APPt.iCATIOIV <br /> llcan.iniomwlloR <br /> . <br /> Ale <br /> „ <br /> �x xc��`•.�r'rx�.�t� T ,...E:... s... .�� � i L, �--r^1�.% �. r <br /> p, <br /> L{C,.� �'' yl Phone: CSC <br /> Phone: - <br /> .• <a r A- ➢.»5: .. 'x4 yrs ,�+ <br /> f <br /> Z Ma CenditloNs of Approval <br /> Revision to: <br /> File No: <br /> 1. Desert 3on of r000sed Revisions: <br /> Li <br /> 2, state the facts showing:the changes In circumstances which make the sub ect conditions no Ion er a ro date or necessa <br /> -� FRo � it✓L � ,�� - <br /> � <br /> _AUTHORIZATION SIGNATURES <br /> R'AN AUTHORIZED AGENT MAY FILE AN APPLICATION. <br /> ONLY THE OWNER OF PROPERTY O <br /> nd its agents,officers and <br /> 1.the <br /> d harmless e county a <br /> employees from owner/Agent i <br /> any claim,action or proceeding against the OWnerlAg nt's project. <br /> 1,further, certify under penalty of perjury that I 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 agent(attach proof of the owner's consent to the application of the property's <br /> Involved in this application <br /> and <br /> dth are true been <br /> veauthorized torr to file n their behalf.,and that the <br /> foregoing app <br /> I I <br /> Print Name: C-(ee(7- '3tMi& rll Signature: v <br /> x.._n......... _-._ <br /> Print Name: _ _�,... . <br /> Date: <br /> Signature:Print Nems: Date: <br /> Signature: <br /> Print Name: Data: <br /> Print Name: <br /> Signature: <br /> -2- <br />