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APPLICATION - REVISIONS OF APPROVED ACTIONS <br /> N:• i i <br /> y SAN JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT <br /> p.. FILE NUMBER: - <br /> 't� aH: <br /> TO BE COMPLETED BY THE APPLICANT PRIOR TO FILING THE APPLICATION <br /> Owner Information Abu Applicant Information <br /> Name: IA1 hl: AWHL M.,Vitl {ItiA.;}rl'�f Name: da4t-TM <br /> Address: 0A47$ 1=%V4Kt- WA10 Address: <br /> 69ti4,WN 4�►1. . �T•s2o <br /> Phone: -jol. Phone: <br /> PROJECT DESCRIPTION <br /> Proposal <br /> Revision to SA - 41-7- 15 Map Condition(s)of Approval <br /> File No: <br /> t. Description of the proposed Revisions: (:2EV1 g101J Ut'Dp"L'>✓ 'T'O t; --4a.o fvt -r FwAszs <br /> 4 -nVIAV L-V-}195A9 U.. V45l 1�� IC- 4YMru6 <br /> covet ON I=Ao "=At 2014 ( 0,1ca'0ASS - pl-►ptN6� <br /> tPYVI e 1.6 01-1 GEc. 31 *:0%0 4x=,0) F-O.'m cd-1t 11-+ 't7 <br /> CV%A- o ^r-I 6ud7rMM Ate„ ?,AI=9'a 4 WA443t+0%JSA". <br /> 2. Stale the facts showing the changes in circumstances which make the subject condition(s)no longer appropriate or necessary. <br /> lklLc u-cu tt✓*�. 4:0J6tr+ �Sph�q d Cont btTl oras <br /> OWtol 0§4+ AslHto rt.Irt-1 oto 5 tats WAS -ttio vY. <br /> ha CL64, <br /> Ike M b91 ,3 i <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 County arising from the Owner/Agent's project. <br /> I, further, certify under penalty of perjury that I am(check one): <br /> tA 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 application of the property's involved in this application and <br /> have been authorized to file on their behalf., and that the foregoing application statements are true and correct. <br /> Print Name: WO.U11G MOI'✓'it Signature: Date: <br /> Print Name: -1syAtt moV'✓'111 Signature: Date: to .-L <br /> Print Name: Signature: Dale: <br /> Print Name: Signature: Dale: <br /> Print Name: <br /> SI nature: Date: <br /> F:WEVSVOPiannirg Appikalion FbrMS\ReV1510115 of Approved Aclions.doc Page 2 of 2 <br /> (Revised 05-11.08) <br /> t <br /> ,4� <br />