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APPLICATION - REVISIONS OF APPROVEDT'��NS� �
<br /> SAN JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT
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<br /> Name: r(.K Ji �e��I Name:
<br /> Address: C i(L Address: IR
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<br /> Phone: �•%�'di �' 7_ Phone: �A f'ti
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<br /> Revision to: Map Condltion/s of Approval
<br /> File No:
<br /> 1.
<br /> Description of proposed Revisions:
<br /> i(\4 twvA - `1 e?.- ;<:.,
<br /> L'111' Use-
<br /> 2.
<br /> sC42. state the facts showing the changes,in circumstances which make the subject conditlon s no longer aro riate or necessary.
<br /> !Ji�k HT1 �dt�QTS �.% ��� �'\.�-��. •r d1 r��:r�iti��ti�U rt ;r:�, I t'�
<br /> AUTHORIZATION SIGNATURES'
<br /> ONL Y7HE<bWNE'Ft ON± rM�:pt7Op tT1F.OFtAN A`UTHOrtZF-D daEN:! AY`fW9 AN APPLICATION.
<br /> I, the Owner/Agent agree, to defend, indemntfy,and hold harmless the County and Its agents, officers and
<br /> employees from any claim, action or proceeding against the Owner/Agent's project
<br /> I, further, certify under penalty of perjury that I am (check one):
<br /> W Legal property owner(owner Includes partner, trustee, trustor, or corporate officer) of the
<br /> property(s) Involved in this application, or
<br /> O 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 /> fi oregoing application statements are true and correct
<br /> Print Name: 1ylLr�G�L: S �1'2-SAA S Signature: y ti "� "" ),K 'C �• )
<br /> Print Name: . late:
<br /> �
<br /> mate: _
<br /> Print Name' Signature: ;I
<br /> Date:
<br /> Print Name; Signature:
<br /> Print Name; Signature:
<br /> Date:
<br /> -2-
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