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pu N APPLICATION - REVISIONS OF APPROVED ACTIONS <br /> �o.'•__'y.cOG <br /> y SAN JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMEN <br /> FILE NUMBER: <br /> TO BE COMPLETED BY THE APPLICANT PRIOR TO FILING THE APPLICATION <br /> Owner Information Applicant Information <br /> Name: ! Z 6' �' LiG'1 Name: <br /> Address: Address: elf <br /> Phone: Z0q- 365-- `�e7 -3 Phone: <br /> PROJECT DESCRIPTION <br /> Proposal <br /> Revision to: Map Condition(s)of Approval <br /> File No: <br /> 1. Description of the proposed Revisions: <br /> X/� l S'r"cin � f ,n'�����rl.�+w``� �c_C i,�-�� v c�-2 �1C,'S�i►�.� <br /> rl T- V� <br /> IL 0 <br /> �'�C�CI-- 1 by 'Is% fi=t�9` \�1/�% �''yl!/!i �-�Y,�l.'i"c� '}' �;k�✓'. � /�+t{..___ ���l'� <br /> 2. State the facts showing the changes in circumstances which make the subject condition(s)no longer appropriate or necessary. <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 /> ❑ 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 foregoin_g-applicatiop statements are true and correct. <br /> Print Name: �L�fi l 12 �,� �� Signature: ' Date: <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 05-11-09) <br />