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t, U"I!t c f. <br /> y� APPLICA11ON - REVISIONS OF APPROVED ACTIONS <br /> SAN JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT <br /> �f;=a FILE NUMBER: <br /> W: CV <br /> I�larne '. <br /> Address: <br /> t. a_,t <br /> } r Address` 3S <br /> �d <br /> Phone o `7 7 " 4s/ <br /> ►'1 ,�} <br /> 1 � i s�.���•s to �� ���'�;' a a ���. � r,�p,��' a" a g <br /> Revision to: Ma <br /> p Condi#iort(s)of Approval k F <br /> File No: <br /> v�Q . <br /> T: Descrip#ion:of the proposed Revisions: i <br /> rn c� <br /> 2. State the facts showing the changes in circumstances which make the subject condition(s)no longera <br /> appropriate or necroessary. <br /> - y. ,S fx 2G r ct G Crl <br /> L C <br /> ,,. ZLZ—) <br /> L i t p r <br /> Qu <br /> I, <br /> b <br /> AUTHORIZATIONSIGNATURES f <br /> ONLY THE OWNER O_F THE PROPERTy`OR AN AUTHORIZED'AOENT MAY'FILE AN APPLICATION. <br /> I, the Owner/Agent agree, to defend, indemnify, and hold harmless the County and its agents, officers and employees <br /> 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, grantor, or corporate officer)of the property(s) involved in <br /> this application, or <br /> Legal agent(attach proof of the owner's consent to the application of the property's involved in this application and <br /> have been authorized to file on their behalf., and that the foregoing application stat ents are true and correct. <br /> Print Namd(:Sew <br /> Signature: Date:� <br /> Print IVame:.�u��-'�j,y�,� �� <br /> �� Signature: Date: " <br /> Print Name: <br /> Signature: Date: <br /> Print Name: <br /> 11 Signature: Date: <br /> Print Name: <br /> Si nature: Date: <br /> i <br /> F\DEMC1Planning Application Forms\Rev€sions of Approved Actions.doc Page 2 of 2 <br /> (Revised 10-19-04) <br />