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°per APPLICATION - REVISIONS OF AMROVED ACTIONS <br /> SAN JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT <br /> FILE NUMBER: -_ <br /> A<iFORN <br /> TO BE COMPLETED BY THE APPLICANT PRIOR TO FILING THE APPLICATION <br /> Owner Information Applicant Information <br /> ,��,)` <br /> Name: T -T Name: <br /> Address: j4'jZ� �J, _f2t7l-PE-\4-�r Address: 0, ` o>( <br /> Phone: Z[x" S6, 7- 45 9( Phone: 2 23�Z <br /> PROJECT DESCRIPTION <br /> Proposal <br /> Revision to: 00-DD - ON Z.. Map Condition(s)of Approval <br /> File No: <br /> 1. Description of the proposed Revisions: o 1 <br /> c. 1 - 1 r -T n r �=�C<'t �_�1 L R {fz IT0 t® C� I C- <br /> Ws <br /> t- e _ L+jL`I i W-Z, AKF-A� �e( R k--e r Jtl� J�n� <br /> � � 10, 2-0 .1 4 tf•F 0 MO �-( hI( . l G- WAS <br /> 2. State the facts showing the changes in circumstances which make the subject condition(s)no longer appropriate or necessary. <br /> au, -ro 14 C- CcirnaT� � � 1�4E _ �. 2 15 <br /> — fir--N C�--. ( I r r cwt- `F d:�, :( <br /> T ofx kl s ©r- <<_ <br /> b Wt:- n Q C IULir C_ r'. 'f-S -LAL- 15JlLjOIOC,, SWt` Eo To <br /> 1.0 C a < In 4,14c r dFc C- <br /> C <br /> AUTHORIZATION SIGNATURES <br /> ONLY THE OWNER OF THE PROPERTY OR AN AUTHORIZED AGENT MAY FILE AN APPLICATION. <br /> I, the Owner/Agent agree, to defend, indemnify, and hold harmless the County and its agents, officers and employees <br /> from any claim, action or proceeding against 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 /> ❑ Legal agent (attach proof of the owner's consent to the applies 'on of the property's involved in this application and <br /> have been authorized to file on their behalf., and that the,for oing appf' atio; statements are true and correct. <br /> Print Name: ;; cC 5L:A)C( Signature: La Date: 7-C' <br /> Print Name: Signature: / Date: <br /> Print Name: Signature: Date: <br /> Print Name: Signature: Date: <br /> Print Name: Signature: Date: <br /> F:\DEVSVC\Planning Application Forms\Revisions of Approved Actions.doc Page 2 of 2 <br /> (Revised 10-19-04) <br />