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<br /> APPLICATION - REVISIONS OF APPROVED ACTIONS
<br /> SAN JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT
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<br /> Na-e: Name: DSS Com an
<br /> y Address Address: 655 W. Clay Street
<br /> Stockton CA 95206-1722 Stockton CA 95206-1722
<br /> Phone: 209 948-0302
<br /> Phone: 209 948-0302
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<br /> Revision to: Map Conditionls of Approval
<br /> File No:
<br /> 1.
<br /> Description of proposed Revisions: SEE ATTACHED
<br /> 2. State the facts showing the changes In circumstances which make the subject conditions no longer aro riate or necessa .
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<br /> AUTH`I�R1AT tN.Sit"� T:ll RES
<br /> ONLYTHE%OWNWiv?F.THE.PROPERTY-flR-Af .AUTHORI EA.J4GENT.MAY;FILE AW"'' A"TION ....,.:;
<br /> I,the Owne:r]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 /> IN Legal property owner(owner includes partner,trustee,,trustor,or corporate officer)of the
<br /> property(s) Involved in this application,or
<br /> 0 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: _ T)aniel A. Silva Signature: Dere;
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<br /> Print Name:
<br /> Print Name: Signature: Date:
<br /> Print Name: Signature: Date:
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