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<br /> APPLICATION' - REVISIONS :OF APPROVED ACTIONS.
<br /> SAN JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT
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<br /> Revision to; Map Condl6nls of Aperoval 71l/� A
<br /> File No:
<br /> F 1.
<br /> Description of proposed Revision$:
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<br /> Z• state the facts showin the changes In circumstances which make the subject conditions no longer a ro riate or necessa
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<br /> I,the Owner/Agent agree,to defend,Indemnify,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 /> 1,further, certify under penalty of perjury that;l am(check one):
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<br /> Legal property owner(owner includes partner,trustee,trustor,or corporate officer)of the
<br /> property(s)Involved:ln this application,or .�
<br /> ❑ 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 /> foregoing application statements are true and correct.
<br /> Print Name: U" J Signature:
<br /> Print Name: � }! _c;[ . ' .f '1�G - -......� I�d,.� irate: g
<br /> r Print Name: Signature:• Date:
<br /> Date: +^=
<br /> Print Name: Signature: Date:
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