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APPLICATION - REVISIONS OF APPROVED ACTIONS <br /> SAN JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT <br /> c4 n FILE NUMBER: <br /> `P/ -��-Moo y <br /> CIFO�� :• <br /> TO BE COMPLETED BY THE APPLICANT PRIOR TO FILING THE APPLICATION <br /> Owner InformationApplicant Information <br /> Name: CSU e r Name: q -e <br /> Address: 2- ? Q V P Address: 2 2 O 7' 4 <br /> C C>4 20 C&tnn C k S 7260 <br /> Phone: S - 5C6 i - LD Phone: 2,0 — cJC6l— <br /> PROJECT DESCRIPTION <br /> Proposal <br /> Revision to: Map Condition(s)of Approval <br /> File No: <br /> 1. Description of the proposed Revisions: <br /> e r rLUT 5 D <br /> EQ 146 <br /> 2. State the facts showing the changes in circumstances which make the subject condition(s)no longer appropriate or necessary. <br /> Uilk f d w �)r fJ�Ll✓) � { c.„Ld U, 0e 6.(i•1 G (Ci S - <br /> / a S ... cv <br /> AUTH0R,i�'s"+i IOi"� ul�GMIA ix.O <br /> ONLY THE OWNER OF THE PROPERTY OR AN AUTHORIZED AGENT MAY FILE AN APPLICATION. <br /> 1, the OwneriAgent agree, to defend, Inderninily, and hold harmless the County and its agents, officers and employees <br /> from any claim, action or proceeding against the County arising from 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, grantor, or corporate officer)of the property(s)Involved in <br /> this application, or <br /> U Legal agent(attach proof of the owner's consent to the appii ion f the property's involved in fill's application and <br /> have been authorized to file on their behalf., and that the fo oin a lication statements are true and correct. <br /> Print Name: (A V' Signature: Date: <br /> Print Name: Signature: L Date: <br /> Print Name: Signature: Date: <br /> Print Name: Signature: Date: <br /> Print Name: Si nature: Date: <br /> F:WEVSVManning Application Fonns%evislons ofAppmved Audws.dw Paget oft <br /> (Revised 05-11-09) - <br />