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APPLICATION - REVISIONS OF APPROVED ACTIONS <br /> SAN JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT <br /> N90�"W-W"11111 <br /> em.7".i, <br /> x <br /> Name: Wo / h L o m e l 5 Name: <br /> Address: 4- Vc Address: <br /> --t o.e7 / I <br /> Phone- .2'i(P 4- -7 4--15 Phone: <br /> .0Q. <br /> R; 50,09" <br /> 0100. -R�ga-MRMX <br /> 221 <br /> MX <br /> Revision to: Map Conditiords of Approval <br /> File No: Siq - o(IR,- oo-I U <br /> 1. Description of proposed Revlslons•A- 19Pf rQ J7 rl A)0,J r5 V) Pq <br /> 4,, 9,*0C1F14 A -7 alms ey vVeele <br /> 6 , /r7sfa/l�ffiah of '"-F 1-0 C-)cl Y,77"e 74o A'sq A7-4- o 14 Wet <br /> 2. State the facts showing the changes in circumstances which make the subiect condition(s)no lonqer a <br /> ppro riat or necessary. <br /> / :i Ile, 07 4 *- )e <br /> or <br /> r My <br /> bv,-4,7e,,-5 , my Ine,7 vvak ov,G�" T.,nc -te, &,R APo, <br /> 0 17 <br /> loads ye.< <br /> W,// I-)ele, be �c,- -n-1 C10.5,f 5, VC <br /> 12le 4 5ecc,.�d C?Ccee< 01C <br /> AUTHORIZATION SIGNATURES <br /> 0 ONLY THE OWNER.OF THE PROPERTY OR AN AUTHORIZED AGENT MAY FILE AIM- APPLICATION. . " <br /> ONLY <br /> TH OV <br /> 0 g <br /> 1,the Owner/Agent agree, to defend, indemnity, and hold harmless the County and its agents, officers and <br /> w <br /> employees <br /> s from any 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 /> E3 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: Signature: <br /> -ale. <br /> Print Name: <br /> Print Name: Signature: <br /> Name: <br /> Date: <br /> Print Name: <br /> Signature: <br /> Date: <br /> Print <br /> Name: Signature: Date: <br /> L <br /> -2- <br />