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tSA - 99 " 95 <br /> APPLICATION - REVISIONS OF APPROVED ACTIONS <br /> SAN JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT <br /> a'�hSf"�f�'i'.w£'�h, r <br /> TQ. ctdrlY^ E112, +ULICANSFw�CRrn It1GTHB>wrElarwx <br /> + r >�z,•x S£ x�xv "z y Er A Ilea[It`htfilw- <br /> wmattcin <br /> '� 3 f�tatfIakurnatfoDy ......: <br /> Name: , I vT SM Name: <br /> Address: 4Vf�T ,1� I�� Address: <br /> G ^� <br /> �-Q G <br /> /�1 <br /> Phone: <br /> ulyo y 5 ""Y k 4 '• t <br /> n `S y'.z'G s ✓s £ 6 3 �z A &'2£n�x 5'"z z 'O <br /> MapCondltionds of A royal <br /> Reviswn to: C' <br /> File No: � - 91 - r <br /> 1, Descrl tion of proposed Revisions: , <br /> S = SH J/jjC, 2 S j�t6 C <br /> T 3 T-sCTC <br /> Z, State the facts showing the changes In circumstances which make the sul conditions no longer aro riate or necessa <br /> E ff c C MOL U PSL�L S%O <br /> 7-6 <br /> t <br /> AUTHORIZATION SIGNATURES <br /> ONLY THE OWNER OF THE PROPERTY OR AN AUTHORIZED AGENT MAY FILE AN APPLICATION. <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 /> I,further, certify under penalty of perjury that I am(check one): <br /> p� Legal property owner(owner includes partner,trustee,trustor,or corporate officer)of the <br /> property(s) involved in 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 /> �,IQ-fit Signature: .... _.. <br /> ,.at•. Z-7-0l <br /> Print Name: _ <br /> te: <br /> _ ... <br /> Print Name: — <br /> Signature: Date: —II <br /> Print Name: Date: - <br /> Print Name: Signature: <br /> Print Name: - — Signature: Dom" <br /> _Z_ <br />