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APPLICATION - REVISIONS OF APPROVED ACTIONS <br /> SAN JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT <br /> ,.:. <br /> 4YYAA <br /> f:�.�6Gq :Yrn�4. 'k35'} ^:,�.:�.�).d�•s�a7.r.•... r�� $�:;�Tif:f�j::2�...1;£:.11,�Y .v S.Jy3.:rt :':Y:f:iv. ..\J.. <br /> �i::::::::,::.:.;:.,.�.:.a:i.};.,•Y:.o.�t:'.: r :. :A'ff �s7��� �f�y �i�,y�Y 1R��• p 1.�...,-.;::%:?r,.,.....:4�.;..>:�»':w::....:.Y:�Yr�.�.,�:.i:�:�::�::. <br /> t:::.,u hY{.::}y ,c.��%a. .��� ..': .�. ?. :.�i�7?'�I<N?,MIT•�'F�MwI �'CR::f��.7':.7��G�T ��J��: ..} :`::;;:<`5<.'Y":>�:%i.'':% <br /> :. yk/' .ix. <br /> ; <br /> Name: CZ;Ro 0 P Name: \C— <br /> Address: <br /> Address Address: <br /> Phone: pyo Phone: <br /> ,1 YJ,... }..v:.::nt.:w::.. ;:Y:Y:;.41}..?..::;•i:i:i::i:y::?•::•:}}y}i;:jiiY <br /> ..h.4Y,:?. Y S:}}A .'+LSv. :.5�:::�•:vt':�:•};4?:ti�{!'yY�:}: <br /> ..a <br /> A.v <br /> . <br /> .t..... <br /> Revision to: Map Condition/s of Approval <br /> File No: 1:� �j <br /> 1. <br /> Description of proposed Revisions: <br /> 2. state the facts showing the changes In circumstances which make the subject conditions no longer aro riate or necessary. <br /> AUTHORIZATION SIGNATURES' <br /> ONLY THE OWNER OFTHE.PROPERTY OR.ANAUTHORIZED AGENT MAYiFILEAN. 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/Agents project <br /> I,further, certify under penalty of perjury that I am (check one): <br /> O 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 /> Print Name: �2 Signatu <br /> IPrint Name: _ _ .ate: <br /> Print Name: Signature: Date: <br /> Print Name: Signature: Date: j <br /> Print Name: Signature: Date: I <br /> -2- <br /> o/e-y- <br />