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APPLICATION - REVISIONS OF APPROVED ACTIONS
<br /> o T BONS
<br /> A SAN'JOAQUIN COUNTY COMMUNITY DEVELOPMENT
<br /> TMENT
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<br /> �'_ -l�_�i Ma Condlt(onls of A royal
<br /> Revision to•
<br /> Fife No:
<br /> 1• Descrl tion of ro aed Revisions: 7 1���
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<br /> State the facts showln the changes In circumstances which make the subject conditions no Ion era ro riattee or neces� .
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<br /> AUTHORIZATION SIGNATURES
<br /> ONLY THE OWI
<br /> ER<OF THE PROPEpRTY OR AN AUTHORIZED AGENT',MAY FILE'AN :AePUCATION.
<br /> d hold harmless the County and its agents,officers and
<br /> I,the Owner/Agent agree,to defend, indemnity,an
<br /> alnst the Owner/Agent's project
<br /> employees from any claim,action or roceeding • 9
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<br /> I,further, certify under penalty of perj ry that 1 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 /> 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 tru n correct
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<br /> Signature:
<br /> Print Name: ate: ----
<br /> Print P.ai+=: _ - - Date:
<br /> Signature:
<br /> Print Name: Date:
<br /> Signature:
<br /> Print Name: Date:
<br /> Signature:
<br /> Print Name:
<br /> -2-
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