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<br /> APPLICATION - REVISIONS OF APPROVED ACTIONS
<br /> SAN'JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT
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<br /> Ma Condition/ of A royal
<br /> Revision to'
<br /> File No. m - _
<br /> Descri tionof ro sed Revisions: ,
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<br /> y 'State the facia owln the chan an in circurnstsnees which make the sub ect conditions no longer aro riate or necessa
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<br /> 1f.TH [N ©F THI .PROPI IZ' YflKA AUT. QR A.AG N'[`:MPiY F:IL> AN .APPlz1CATlOIV'
<br /> i,the owner/Agent agree,to defend,Indemnify, and its agents,officers and
<br /> nify,and hold harmless the County
<br /> employees from any claim,action or proceeding against the OwnerlAgent's project
<br /> :
<br /> I,further, certify under penalty of perjury 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 /> T 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 Elie on their behalf.,and that the
<br /> foregoing application statements are true and correct
<br /> tf1 — slc_fnature:
<br /> Nae:
<br /> Print '" caste:
<br /> Print Name: � ... ,� ; Date:
<br /> signature
<br /> Print Namet p
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<br /> '•^""- etal
<br /> `Signature:
<br /> Print Narnu: -77 _ -~ pate:
<br /> - - y signature:
<br /> Print Nan•►e• -
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