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Dec 04 06 10: 40P Joshua Borgett (2091 368-8240 p. 2 <br /> ' APPLICATION - REVISIONS OF APPROVED ACTIONS <br /> ,.. ..p <br /> SAN JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT <br /> FILE NUMBER: - <br /> P <br /> To BE COMPLETED BY THE APPLICANT PRIOR TOTILING THE APPLICATION <br /> Owner Information' - Applicant Information <br /> Name: - Ln <br /> Name:��; b �2M <br /> Address: <br /> Address: � '� 1 •� c� G � <br /> Phone: - 7 Phone: <br /> PROJECT DESCRIPTION - <br /> Proposal <br /> Revision to: Map Condilion(s)of Approval C <br /> Fle No- - — <br /> 1. Description of the proposed Revisions: <br /> LG L1 <br /> n <br /> _ 1 � <br /> 2. State the facts showing the changes in circumstances which ma the subject condltkn(s)no longer appropriate or necessary. <br /> AUTHORIZATION SIGNATURES <br /> r7ach <br /> E OWNER OF THE PROPERTY OR AN AUTHORIZED AGENT MAY FILE AN APPLICATION. <br /> rlAgent agree, to defend, indemnify, and hold harmless the County and its agents, officers and employees <br /> im,action or proceeding against the OwnerlAgenCs project. <br /> ertify under penalty of perjury that I am (check one): <br /> roperty owner(owner includes partner, trustee, grantor, or corporate officer)of the property(s)involved in <br /> plication, orggent(attach proof of the owner s consent to the application of, roperty's involved in this application and <br /> have been authorized to file on their behalf., and that the fore of tication statements are true and correct. <br /> Signature: - Date: <br /> Print Name: �Z. y/•O(� <br /> 6 :J�t>`1 <br /> Print Name: ��5� IVCL' L� Signalura` Date: <br /> re- Date: <br /> Print Name: <br /> Sig <br /> Print Name: <br /> Signature: Date: <br /> Dale: <br /> Print Name: <br /> Si naWre: <br /> F:0EVSVcI3i3nning Appr"Von FormsVdevisions al Approved Actions.Coo Paget of <br /> (Revised 10-19414) <br />