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< - gyp-- 00oZ <br /> APPLICATION - REVISIONS OF APPROVED ACTIONS <br /> SAN JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT <br /> K,,h , g..� m u .n '",+ '4.d§r 16"n ,a � ! db�A PW( o-x <br /> �t3Es M1 § Y 7,E p..1. I+I il, 'SARP,YI5C0h'1 2�d" <br /> ca n Atria <br /> Name: eAe Ais <br /> .f. ., Name: G <br /> Address: Q 113 / Address: <br /> -95 23 Y hip L-- ysz3 <br /> Phone: V — b5-- 1F,L4 13 <br /> 1 <br /> Omsk 4 r <br /> Revision to: Map Conditionls of Approval <br /> File No: /� <br /> 1. Description o/proposed Revisions: X �rr A C [Nn T U <br /> Y <br /> -4Z LRI)WWL U � C-01)SLIAL <br /> 2. State the facts showing the changes In circumstances which make the subject conditions no longer aro rlate or necessary. <br /> / is f O <br /> t) C&ZZ4 <br /> la S <br /> v - v <br /> c r- <br /> -6Id ! /J Lo 7 P co N TUU, <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 <br /> employees from any claim, action or proceeding against the Owner/Agent's project. <br /> I, further, certify under penalty of perjury that I am (check one): <br /> o Legal property owner(owner Includes partner, trustee,trustor, or corporate officer)of <br /> the 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: meg(. o��N Signature: �`' Date: [t <br /> Print Name: �lA-2L-�tnt Signature: Date: ) <br /> Print Name: Signature: Date: <br /> Print Name: Signature: Date: <br /> Print Name: Slgnature: Date: ij <br />