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APPLICATION - REVISIONS OF APPROVED ACTIONS <br /> '„ l ', • `�'� SAN JOAOl.11N COUNTY COMMUNITY DFVEL 1= r <br /> .—„FILE NUMBER: - <br /> TO B COMPLETF_D�Y tHE APPLICANT PRIOR TO FILING THE APPLICATION <br /> {)�evrier Ipfarrrlatigi't - Ap�licarrt'Informat{un <br /> Name: L Narnw <br /> Address: .01Sin, Address: 170. dLAI <br /> q�,A CA <br /> Phone: LLProne: L�11 11 <br /> 1'46j7 ,CT 6ESC011PTI6N <br /> Revision to: pJAL_ Map Condifsan s of A proval <br /> File No: <br /> I. Description of the propoGed Revisions: <br /> r! I Nr� I V C�? I= l uiGDi�vw� e Z. 1. �i 5 h G 5.r:, ro '�c 't-0 <br /> �- �" P��c E=5�1 VGA �crlGd�l��/C�� 1�! �'Z�' S1' R�i�r Cer7v �{�--��f'"�i:�7�✓�i� �� <br /> 2. State the facts showing the changes in circumstances which make the subject conditions no longer ap ro riaie or necessar . <br /> lir. cTr s <br /> �vnr -Feut-r -rlfC il&4rrw 54o.. t, <br /> AUT HOR1ZA71I 1 'IGNATUR$ <br /> ONLY.THE-OWN 8R OF THE PR&P_R.TY�OR iii' AUTHOR-1ZED'AGENT-MAY Fl�E AN ARPLlCiA�.l�N. ': <br /> I, the Owner/Agent agree, to detcnd, indemnify, and hold harmless the County and its agents, officors and Pmployees <br /> from any claim, action or proceeding against the County arising from the OwnerlAgent's project_ <br /> 1, further, certify under penalty of perjury thrst I am (chock one): <br /> Logal proporty owner{owner includes partner,trustee,grantor,or corporate officer} of Ilia property(s) involved in <br /> this application,or <br /> ❑ Legal agent(attach proof of the owner's consent to the application of the property's involved in this application and <br /> have been authorized to file on their}behalf,,and that the fa oin a lication statements are true and correct. <br /> Print Nemo- f/ r �� �V� Signature: --1111,�14, �' �� `r Datta: .� �l •��� <br /> Print Name: Signature: <br /> Print Name: Signature: Date: <br /> Print Naniw � Signature; — Date:_�- <br /> Print Name: Signature: Date: <br /> I-:0LVSVCII'tannlnp AppllceGon F[KfiWRav1s10f;K tit Appruvwi AcXtins.tloc Pago 2 of 2 <br /> (Kavisod U�19•fY9] <br />