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APPLICATION -- REVISIONS OF APPROVED ACTIONS SAN JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT qp FILE NUMBER: TO BE COMPLETED BY THE APPLICANT PRIOR TO FILING THE APPLICATION Ow. r Information Applicant Informed" Name: sn ard, Name: 1 Gl\ae- i1 Address: (-4L W , Nli�ld�� Address: I34D0 1,L) k M WicgA — I (ore CA +5304 TrA g530 Phone: o - 235-44'73 Phone: a0 /y-L/[i73 PROJECT DESCRIPTION Proposal Revision to: ro veoSC Map Condition(s)of Approval File No: U — t)pD3„ 1. oesalpti5on of the Revisions: ✓� t.' a ru` ✓al i� - / a e/u+ae - aAi r ConS' IA-)l 4 r se v Len tars a shdwit n �lq u i- e 2. State the facts showing the changes in circumstances which make the subject condition(s) no longer appyPrIft or necessary. 1 a5e� D eelllopUC /17 Aake. heeA. Welateed. e,-,— A��!/zrahl in I D AUTHORIZATION SIGNATURES ONLY THE OWNER OF THE PROPERTY OR AN AUTHORIZED AGENT MAY FILE AN APPLICATION. I, the Owner/Agent agree, to defend, indemnify, and hold harmless the County and its agents, officers and employees from any claim, action or proceeding against the County arising from the Owner/Agent's project. I, further, certify under penalty of porjury that 1 am (check one): Legal property owner(owner includes partner, trustee, grantor, or corporate officer) of the property(s)involved in this application, or ❑ Legal agent(attach proof of the owner's consent to the application of the property's involved in this application and have bee n authorized to file on their behalf, and that the in a I' tion statements are true and correct. Print Name: 1�'1 1 pe I Ft— Signature: Date: Print Name: Signature: Dole: Print Name: Signature: Date, Print Name: Signature: Date: Print Name: Si nature: Date: F:1oEvsvCWlOnnlno Apprp.rbn Fa %ROrlslon at Approved ArXonn.A Page 2 of 2 (Revbed 05.,1-00)