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<br /> APPLICATION - REVISIONS OF APPROVED ACTIONS
<br /> SAN JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT
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<br /> Name: TA17-2-2-7
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<br /> Phone: A 9-0 C>
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<br /> Revision to: Ma Orr 5 —/ Condition/s of Approval
<br /> File No:
<br /> t. Descri tion of proposed Revisions:
<br /> 2. State the facts showina the changes In circumstances which make the subject conditions no longer aro riate or necessar .
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<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 /> 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 rrect
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<br /> I Print Name: --•- ... _ •-'----
<br /> Print Name: Signature:
<br /> .... Date:
<br /> Print Name: Signature:
<br /> Date:
<br /> Print Name: Signature:
<br /> Date:
<br /> -2-
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