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APPLICATION - REVISIONS OF APPROVED ACTIONS <br /> SAN JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT <br /> . ., z G�6YaTF3RJtRPOCDU)i[SRWS4IR; YFJ�C'eLH ,PUCAT[ON :a."E H <br /> '�,� "8'�axHs<' > �'§?fy{`� „F+, <br /> :, ,_,2 <br /> Name: Name: Iax� EG-1 [ <br /> Address: Address- L7 <br /> Pil <br /> 1 +ami 23 IHoil I CA 95 <br /> Phone• r' - <br /> Phone: <br /> ........ ....... . ........ . <br /> .f>Hie� �.`C��`�� - <br /> ec h _ <br /> a 5 . <br /> 2 <br /> Revision to: /H �7�{�J/, ! 17 CanditlorJs ofAPP <br /> roval <br /> File No: ' Z <br /> t. Description or Proposed Revisions: .. <br /> t7211 / <br /> t <br /> 2. State the facts showing the changes In circumstances which make the subject conditla s no longer appropriate or necessary. <br /> " . 4tiTHOR1ZF�'G[ON SIGNATURES "' <br /> ONLYTHE:OWNEROFTHEPROPERTYORANAUTHOR=AGENT,MAYFILEAN APPLICATION. <br /> I, 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 Owner/Agent'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 and have been authorized to file on their behalf., and that the <br /> foregoing application statements are true and correct <br /> Print Name: <br /> ..� I Signature: •" — �p� <br /> �'t QEfa � ��' <br /> Print Name: _- <br /> Print Name: Signature: Date: _ <br /> g <br /> Print Nano: <br /> SI nature• Date: <br /> g <br /> Print Name: <br /> SI nature: Date: <br /> _o_ <br />