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i <br /> APPLICATION --- REVISIONS OF APPROVED ACTIONS <br /> SAN JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT <br /> FILE NUMBER: -��__ GQ L • <br /> M %r�'Ay; ;:,'Sw r:jiyif� E�;. � r •; �e �... ' i . iq ni. d j�'' r)k,h r <br /> CM. . �: ' �. i, n {,. 'a{ f Fly.. , .,r,;• el i4'F r4',,. <br /> Name: 'M Name: = . <br /> Address: 2 � p o � C Address: -- ' <br /> --- <br /> Phone: Phond: - <br /> IM <br /> ,(ul <br /> ' �tfN a .w i � L •'qJar u1 f } r itkf. ' <br /> ' i. <br /> � <br /> N 1'..'a.,` i' .,�,;. n�',•`��.' St,�.r,.i 1 ' C�. )7wh".,1,+{ }� .,�� �� r�trj''"� S r" i�ii �7 !YA tfr; it i '� rti p <br /> Revision to: �? Map Candltion(s)of Approval <br /> File No: 1-\ �A.\ <br /> 4. Description of the:proposed Revisions: r.... <br /> 2. State the facts showing the changes in circumstances which make the aubject condition(s)no longer appropriate or necessary. <br /> c <br /> -� <br /> AUX' ZA►Tft�M T, ,'Reg, <br /> ONLY THE OWNER O fj,- RR60l�.ili�Ty OR AM AWAW-t�a e T�p � AION. <br /> 1, the OwnertAgent agree, t6i defend,_indemnify, and.hoW,hiarmless the`GoU i and its <br /> from env claire, action or proceeding against the Owner/Agent's project. n and employees <br /> 1;f,LAer, certify under penalty of perjury that I am (check one): <br /> Legal property ownar(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 game: „ L ( L Signature: <br /> fiu Date: <br /> Prinz Name: Signature: <br /> Date: <br /> Print tame: Signature: <br /> Date: <br /> Prinl Narn�o: Signature: <br /> - Dams; _ <br /> Print r,�ama: <br /> ---.Signature: <br /> Dale: <br /> F;0EVSVC\PJanning Appllcal)on Forvns\Rev13t0nS W Approve Actlons.Voc page 2 of 2 <br /> (Ravised 10-19-04) <br /> 700 A <br /> TN 71ny-� r — <br />