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APPLICATION - REVISIONS OF APPROVED ACTIONS <br /> SAN JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT <br /> A-0.4i <br /> NOUN <br /> ............... <br /> ................ <br /> 4 7iQAC V A:?, /-Z <br /> Address: ILO)A16,V A/ Aa,/ •-) qel Address: <br /> Phone, Phone: <br /> Revision to: Map Condition/*of Approval <br /> File No: <br /> I Description of Pmposed Revisions: <br /> 2. State the facts showing the changes In circumstances which make the subject condition(s)no long r appropriate or necessary, <br /> i /Z- <br /> gf'—A.) aZAJ4ra-1,2— <br /> Z4&S a.E,1x)A 1p'"eLrdEL <br /> AUTHORIZATION SIGNATURES <br /> ONLY THE OWNER OF THE PROPERTY OR AN AUTHORIZED AGENT MAY FILE AN APPLICATION. <br /> OWNER <br /> 1, the Owner/Agent agree, to defend, Indemnify,and hold harmless the County and its agents,officers and <br /> action <br /> 7remployees from any claim, action or proceeding against the Owner/Agents 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 /> 0 Legal agent(attach proof of the owner's consent to the application of the propertys <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; AV,�&-&— /1�2, Signature. <br /> A <br /> Print Name: <br /> Print Name: Signature: Date: <br /> Print Name: sle�latvre! Rafe: <br /> Print Name: Signature: Date: <br /> -2- <br />