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APPLICATION - REVISIONS OF APPROVED ACTIONS SAN JOAOUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT 4 t.•3 ¢'+G��.� �., F"+#d 3' <Y �,��:Y;�iaO�u{'��':�:�c;;e Name: SrE6r - iti/6- 70 Address: Address: o 4114it/,-Ez 953 sVzaG,L iv y. Phone: 09 Z " Phone: Tpvr. �!?A p Fe Revision ta• Ma L L � OS �^ Candltlonfs of Approval File No: 1. Description or 2Mposed Revislone: i tis Z• State the facts showing the chanes In circumstances whteh make the subject conditions no Ion era o riate or necessary. 9QM71 - e Vl1r'Da perinl�'�AE Awllf? rtiT rL�D N N T v' L I O O W 4 r ilIN v � u N6 2aPEleTt! 11/ tJG /v -. _. r;. •�e�� "s Y ,.3 ° da .a '4d }r} {• F [ {i( �r is, K �4i '� � - , � { r { �- ,,� ..,. .,......... ................. .......:::�::.:�:��:::::.::.::::�:�::i:..,•v.•.:......�2:.2 .::{v:;:;i:i:.:eYY�:�iY�:i':{�::T'hT i':: ..w4•.•.r.r.... .... he M1..:?...r}..::`Y •.R.v...:,:- .{.Z:}:Y. .0: \:2'if2•%im:•:ri^:.}Y:....�: 2v v.: :4•:r:frx .o- r r:. .Nf... .} ,�.i.>�.,'t'. ........:...:..'. :..r.:::.••Y',{i;:,' :•::•4.1n.i:•:•Y+."ri'.'i' ,*�. ".. ..::.':. n . 4,S:.i^:•..i,r. .Y•:r:.!. •Y'.v:: ...,•.,'...oa �a ,^A, +; r ^�. 4 :� TH � aErYry' br » T':M ' � i : 1�,.4pPfcd'�ols'; •. I,the Owner/Agent agree,to defend,indemnify.and hold harmless the County.and Its-agents,officers and employees from any dlalm,action or proceeding:against the Owner/Agent's project. ; 1,further, cetft under penalty of perjury that I am(check one): 13 Legal property owner(owner includes partner,trustee,trustor,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 been authorized to file on their behalf.,and that the foregoing application statements are true and correct i r 4 re: .!7ate ` d / •• Prink Name: V*&natu Print name: �, ........• .._...�.....� . . ...._.. Date: Print Name: Signature: _ Date: Print Name: Signature: Date: Print Name: Signature. Date: