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f <br /> I <br /> APPLICATION - REVISIONS OF APPROVED ACTIONS <br /> SAN JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT <br /> ;>+ C L F� R7OtFIE.IIVGTHSAPPGI�AFION <br /> A' licant tnformalfon <br /> Name: Name: / z- <br /> Address: 2)to O Address: 0 /Zog— <br /> 4J•1L QDb <br /> srovc ro G1t Sr.�rxo CA 952/6 <br /> Phone: Z09 7(p -D9G Phone: Z�y��7G-P7(o8 <br /> PROJECT DESCRIPTION <br /> Revision to: Map Condition/s of Approval <br /> File No: �7�• 9� - (p C� <br /> 1. Description of proposed Revisions: fIPR`?t� 7�� N�� $uc r.7 /j/ySd,✓iM.Y <br /> W.Q-t-!_ LIS � SC,Z Elyr OA( T/t'� f[/E fJND SouTirL .�.•tv.Df•ZTY L,NES . <br /> 2. Stale the facts showing the changes in circumstances which make the subject conditions no longer aro riate or necessary. <br /> �c7<.�o-�- /Ytq�vcc-Fll�Trs �.l cr S !Vetl a oA/ I - O <br /> QST 7W;S J��rP6o•-T>', 714E-;¢� I oNGY 11 A4 f, L�ESiDt <br /> Ga� PL&,o.S L- 2t;�6-rz 7—o TiLb <br /> T/J-6 <br /> I�izJsc� i(fbw Tozs��� 73 .' :,6 7!y{�¢b psa� Ga►..r�+� <br /> /l1.�6r< iJlc��.,.. Ti+ (;fNvxBisTS m.! � 4.tsT Rua EAST Si.�ts ai- <br /> r �Zd- Y i4•s-�D �/�'t i.v-7 i�AVL Sc'.2t 4iiCLL <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, indemnity,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 /> t,further, certify under penalty of perjury that I am (check one): <br /> ❑ Legal property owner(owner includes partner, trustee, trustor, or corporate officer)of the <br /> property(s) involved in this application, or <br /> jZ] 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:��"�aT+�Y /k-q�..r LZ Signature• Date: <br /> Print Name: Signature: Date: <br /> Print Name: Signature: Date: <br /> Print Name: Signature: Date: <br /> Print Name: Signature: Date: <br />