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APPLICATION - REVISIONS OF APPROVED ACTIONS <br /> SAN JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT <br /> . . , . . ,...... to .. .: . a <br /> :. `..,.. Su .aid's O. . zr.v; •.� <br /> Name: rl I INe , rQIG11 ear A 11 <br /> ame: n � r a•TQS .. . <br /> Address: P Q N <br /> 002_ Acidness: ,O. ?�1t 15002_ <br /> --ar-Mme4p. CA 95$51- 10402- <br /> Phone: 91(v t} - 331 Phone: 91<0 <br /> -3519 [..Mlle. Nob(¢ <br /> a ? <br /> Revisionto, ttafr EWwa, , Condidonts of Aeproval 1 IJ.C3� 1 <br /> File No: X - 1 - 2- se: }}n yr} _ CA Mt%e- I D ' "q I-3 - 0005 <br /> t• Oestri tion or Rwiabns: TCjl�her' A �2s -Ye I LLr <br /> ea-c 1r1G ¢ le. r 1 lrrt Inln 12 <br /> z. State the facts showin the than es In circumstances vedch make the au6 condition(s)no longer ato or necessary, <br /> t r' le E IAGOfo pumhase-+his below- rude proMr.4k <br /> n + tlA rot fee n1-. <br /> Citation oi vura.11s <br /> t al Teidter { 10 eom I 3 it rec6m <br /> b In r 31 E a.i on n tn. <br /> Mt Wk OV Rose' rIII <br /> 1 .The, i)VI reclama t <br /> resat r'cuJ r t il+e rc iortFle�t Eht Ia len <br /> e' n r in mllnlal <br /> k <br /> . = Warrsr r WFUF � <br /> ON Ly ©F,;,'IN�RC1'OREI��tIF� IIIkTH(7hi�GENFMlE1FTILIrA1iItPPLICATION. . .. <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 I am(check one): <br /> IH/ Legal property owner(owner Includes partner,trustee,trustor,or corporate officer)of the <br /> property(s) Involved to 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: ��.} )} I'larrte.I Signature: <br /> Print Name: <br /> ,:ace: <br /> Print Name: Signature: Date, <br /> Pint Name: Signature• <br /> Date: <br /> Print Name: Signature: <br /> Date: <br /> -2- <br />