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APPLICATION - REVISIONS OF APPROVED ACTIONS <br /> SAN JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT <br /> <• '• '�� � •, 'CCJI�&��kNIFBt. x'34 � a � C GtG�ANT� ,��PI4Tt0. � ���� `� r` <br /> kph xu ,� •. . . <br /> .. ... Com: <br /> C <br /> y g . <br /> ( ✓(L IiCC i N.C/ Il'�C�C� Name: ,'c'_i,H 1 L✓ 1✓Oh Hn .�G� SP✓JI off lJ <br /> Name. p II <br /> '� � IN1J r1 Address: t<cv j'1511 t (`C <br /> Address: LSV <br /> Lort Cu . ZI-11 19c ro, Ci, s 2 7 <br /> Phone: 'ZJ - 7tv ct you Phone: -7 <br /> 11 Oil <br /> i < x nz?.� `,iis'�<7#`sYttU�x<`fi <br /> ' � '` R E' i�.s<� .<' Yi>..<�'E" ."xY.;ken•;b e� �..<' �ST� a>,£ i;�... � <br /> 51. <br /> Revision to: Ma ConditloNs of A royal <br /> File No: 5 — 73 I <br /> 1. Dsscrl tion of proposed Revisions: <br /> fp 1 (M a Lvv 2 20U 2 <br /> 2, State the facts showing the than es In circumstances which make the sub ect conditions no Ion era ro riate or necessa . <br /> wa .,41 K 1- w G L+n <br /> 7 I r✓ ✓ t 'f o v✓i. d- eye AewFG L)-s <br /> Jrl k f Ll ,- s s <br /> a� 1 � r ctt <br /> -A-;Ae rtv <br /> u-lt t f 1 <br /> X. <br /> .was , ;. .... .. <br /> a <br /> ONL >, lt; O <br /> c 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 /> 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 /> i <br /> Print Name: (CtyI Signature: maa.tii __.. ..... . natr. ..7 Z .. <br /> IPrint Narne: 'a l .. I <br /> Print Name: Signature: Data: <br /> Print Name: Signature: r Date: <br /> Print Name: Signature: Date: <br /> -2- <br />