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APPLICATION - REVISIONS OF APPROVED ACTIONS
<br /> SAN JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT
<br /> FILE.NUMBER;
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<br /> TO BE COMPLETED BY THE APPLICANT PRIOR2'TO FILING THE APPLICATION
<br /> Owner Information Applicant Information
<br /> Name: a'r�•d�'t:'Au'>,
<br /> Address: I �.� �`°+r:`~- f.Lat �'��i .s. Address:-' :
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<br /> .i PROJECT DESCRIPTION
<br /> Propo'sar
<br /> II Revi=:cn tet�,S< Map S �} ;5 " Condition(s)of Approval
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<br /> u Description of the proposed Revisions,•1� t. a 1',-U%IvL{
<br /> -� ry:, -t,t'� C,irtc-e t= `,•1rt5�s` �L�:s ra :•,a'
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<br /> i Sate the facts shorting the chances in circumstances which make the subject condition(s)no longer appropriate or necessary.
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<br /> AUTHORIZATION SIGNATURES _
<br /> s ONLY THE OWNER OF THE PROPERTY OR AN AUTHORIZED AGENT MAY FILE AN APPLICATION.
<br /> i, th= CwrarAgent agree, to defend, indemnify, and hold harmless the County and its agents, officers and employees
<br /> 'r For-any --aim,action or proceeding against the County arising from the Owner/Agent's project.
<br /> f.furtl er.certify under penalty of perjury that I am (check one):
<br /> Legal property owner(owner includes partner,trustee, grantor,or corporate officer)of the property(s)involved in
<br /> ;his 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 foregoing a lication statements are true and correct.
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<br /> Print-Name: �VA,0- Signature: %A� Date:_
<br /> Print Name: Signature: Dale:
<br /> Print Name: Signature: Date:
<br /> Print Name: Signature: Dale:
<br /> Print Name: Signature: Date:
<br /> F;;DrVSVC`:Planning Application Forms\Revisions or Approved Aclions.doc Page 2 of 2
<br /> (Revise-,'05-1 1]g)
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