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APPLICd�TION - REVISIONS OF APPROVED ACTIONS c f < SAN JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT FILE NUMBER: - <ik'o' aj x, rifol'nie{tart - .,;e �lW ,rr .z tq Ap ,�ni0 pp2Sn Name: Aft CAALk �tJn+hroNi Name: lWel/ G.ren,i✓J ASa+✓ 4`�R+ CAuk Address: /(/7/ Louxt.- .Sa"L4 A*AG Address: / La D ) cot 9 s-av - or r2YL Phone 2Q9 9S/ 9 19 Phon 20/j 3t:4— 226L 1 7 PatafEcr nE;; �T . 4+. ' rrof ,i- Revision to: Map Condition(s)of Approval File No: 1. Description of the proposed Revisions: we A ac Oe I tfe-s"l+ 41»w i F erfij e% Tivt rve..�f�� zy� 2. State the facts showing the changes in circumstances which make the subject condition(s)no longer appropriate or necessary. As ufe 94JAlrmo ovl &WS A&CHoJ la✓f 4r/D Sr. a� �?ta.r. OkA- dUt 'fa brd ('o A No`s itJereAse frl if-a (C-42. Aq r✓e,ts- '2116G-00,600 Ove. bu -L+-- We M1e tlel u ADDr-ITWA/ 41lout U.S To jee-00 vap"t orJkf - Qr� rrrtevr Lotdty Col• X*t.acf{or-) Co5"IT 4,pijp R4Ue A DOf-hbup 1 AwmrEs _ AUTHORIZATION SIGNATURES ONLY THE OWNER OF THE PROPERTY OR AN AUTHORIZED AGENT MAY FILE AN APPLICATION. I, the Owner/Agent agree, to defend, indemnify, and hold harmless the County and its agents, officers and employees from any claim, action or proceeding against the Owner/Agent's project. I,further 'fy under penalty of perjury that I am (check one): Legal property owner (owner includes partner, trustee, grantor, 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 ore oing a lication statements are true and correct. Print Name: tWi bion, L • C unem iW Signatur : 'a Date: Print Name: Signature: Date: Print Name: Signature: Date: Print Name: Signature: Date: Print Name: Signature. Date: F:0EVSVC\P1anning Application Fonns\Revisions of Approved Actions.doc Page 2 of 2 (Revised 10-19-04)