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APPLICATION - REVISIONS OF APPROVED ACTIONS <br /> SAN JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT <br /> TO BE COMPLETED BY THE APPLICANT PRIOR TO FILING THE APPLICATION <br /> I Owner Information Applicant <br /> A lican�t/Informatiion� (� 1 <br /> Name: 110 N Name: ! 1 Y �i�SiM(/7-N'. .t'._`.7 <br /> Address: �� rj, �/.>< Address: .�, (D t(J{I <br /> Phone: �zef?\; =T 1 ✓ 11 Phone: (20 9) SrM <br /> PROJECT DESCRIPTION <br /> /.� <br /> Proposal . . <br /> Revision to: lT t-+ � A(F Map Condition/s ofApproval <br /> File No: A - )- !S7- <br /> 1. <br /> S21. Descri tion of proposed Revisions: <br /> Lgxrf- <br /> I u IMf60`Jf W!V tp so M-' <br /> �viL�trJ� wtlTs WrrWO O D c- <br /> 2. State the facts Showing the changes in circumstances which make the subject conditions no longer aro riate or necessary. <br /> 5 I5 AQ uwAEU- sttArr 1T. TI <br /> `h011-,OIPCO f C AI`/`' 'ffz ACrtt �ff- (k-) 1LJ6LM4TT0 <br /> f i9tJGK F66 AI.AT 4DO <br /> 2- <br /> AUTHORIZATION SIGNATURES <br /> ONLY THE OWNER OF THE PROPERTY OR AN AUTHORIZED AGENT MAY FILE AN APPLICATION. <br /> 1,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 /> o Legal property owner(owner includes partner,trustee,trustor, or corporate officer) of <br /> the property(s) involved in this application, or <br /> o Legal agent(attach proof of the owner's con;co <br /> n he applic ion of the property's <br /> involved in this application and have been orized to file n their geha If., and that the <br /> i foregoing app!ication statements are tru r <br /> /^ <br /> Print Name: Signature: Date: o- d <br /> Print Name: Signature: Date: <br /> Print Name: Signature: Date: <br /> Print Name: Signature: Date: <br /> Print Name: Signature: Date: <br /> R6VOFAPPROACFAPP FORM R6V.8-10-01 <br /> -2- <br />