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- <br /> I>Y. APPLICATION -- REVISIONS OF APPROVED ACTIONS <br /> SAN JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT <br /> FILE NUMBER, <br /> T0: E POWIPL'ETED'BY THE-APPLICANT PRIOR TO PILING THE APPI-tCATIOd <br /> Owner'Informatlon Appllcant,Informatlon <br /> Name: S �pi21L�. Name: ti t�� 7�r' 1 �1�1 <br /> I Address: <br /> Address- �> >f5c: , <br /> s . •� c� ��'S _� Gtr �� f <br /> Rhona } :age, <br /> PROJECT DESCRIPTION <br /> s Proposal <br /> Revision to: c,- _S Map 2 ti==' Candition(s)of Approval <br /> FHe No: <br /> 1, Description of the proposed Revisions: t p - 4-- P - O— <br /> C� - 4- �/�R r-L E'W i <br /> i <br /> 2. State the facts showing the changes in circumstances which make the subject condition(s)no on appropriate or necessary. <br /> I <br /> I AUTHORIZATION SIGNATURES <br /> ONLY THE OWNER OF THE PROPERTY OR AN AUTHORIZED AGENT MAY FILE AN APPLICATION. <br /> [from <br /> the Owner/Agent agree, to defend, indemnify, and hold harmless the County and its agents, officers and employees <br /> any claim, action or proceeding against the Owner/Agent's project. <br /> 1,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 proporty(s) involved in <br /> this application,or <br /> Legal agent(attach proof of the owner's consent to the application of the property's irvolved In this application and <br /> have been authorized to file on their behalf-, and that the fckegoing applitation statements are true and correct. <br /> Print Name: Tcx(V Signature: Date: <br /> Print Name: Signature: Data, <br /> print Name: Signature: Date: <br /> Print Name: Signature: Date: <br /> Print Name: SI nature: Date: <br /> F:1gEv5vClFlanningApplfcatlon FurmslRavlsiOrLs arnppMV*d Acuvns,dvc Page 2 of 2 <br /> (Rvrlded 10.19-04) <br /> i <br /> k <br /> i <br />