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APPLICATION - REVISIONS OF APPROVED ACTIONS <br /> SAN JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT <br /> .. ... <br /> 'fa y{ 3s3a<'J$>r., . �', ,f3ki';� m `ks&;:•C•'2� �Fr2'�kia 'S3� <br /> x7 Y, x<¢Y' tCH"" `3:r •S•<�£ ,ffi xmr <)95.$?.:. n ttl IOR' <br /> Name: i V e H E (�. (E� Name: <br /> Address: Z l (J ( S • L---E 6160 Address: <br /> T2 P-c� 0 ft <br /> / a G_3(D.k <br /> Phone: Z U� V lC7 t li Z Phone: <br /> �P•'•_40069� /, , {..• .0 / ' <br /> k <br /> h. • �4ii 4y.4y )rC CJ'f,, . Y / <br /> );Y. . ,.xRMr< <br /> Revision to: Map Conditlon/a of Approval <br /> Re No: — l <br /> 1. Description of pniposed Revisions: <br /> '7-0 01Ge hbcL 10 <br /> CJ0 il::> NL) P fly <br /> � Com F0 2Vti —a E � W �(5 �4 IF— D I dJ <br /> 2, state the facts showing the changes In circumstances which make the subject conditions no longer aro riate or necessary. <br /> W1 �C � fN Ct= ~ <br /> E FC-e_ <br /> �Mta.`aM ... i. :XAUT,M[ORIZA7IONs�SI NI�t kU.:EfES.. s. M w <br /> ONL1FWw <br /> '1HpWNEl2O�..kFfPIOP {FZiC1Ft11NAtiTHBh1H[ItlA'GE�ITXMJt!IIL11N<IaPPLICATION. fb <br /> I,the Owner/Agent agree.to defend,Indemnify,g Ity,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 /> 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 appilcation and have been authorized to file on their behalf.,and that the <br /> foregoing application statements are true and correct <br /> i <br /> Print Name: 4(iii it V_cCke rt,,' II of Signature: )ate; <br /> LPtint <br /> e: _ '•..•^........ <br /> e: Signature• Date:e• Signature• Date• <br /> e• Signature: Date: <br /> -2- <br />