Laserfiche WebLink
'� APPLICATION - REVISIONS OF APPROVED ACTIONS <br /> r.' y <br /> e: SAN JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT <br /> fF,,,aa FILE NUMBER: -�)�_ ( U <br /> NTOB <br /> jInformation <br /> PLETED BY THE APPLICANT PRIOR TO FILING THE APPLICATION <br /> Applicant Information <br /> Name: Pr-h, . 6, L( Nam :Address: L 4 +G ress: D.2 �Zr 9Lod-. 9 !S2--{Phone: O ? o✓'! -y�>-(J?il Phone: C, <br /> PROJECT DESCRIPTION <br /> I <br /> Proposal <br /> Revision to: Map Condition(s)of Approval <br /> File No: 41 - 00-s <br /> 1. Description of the proposed Revisions:: 2 F�115 c t <br /> T TO 10-F C111110-d <br /> 2. State the facts showing the changes in circumstances which make the subject condition(s)no longer appropriate or necessary. <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, indemnify, and hold harmless the County and its agents, officers and employees <br /> from any claim, action or proceeding against the County arising from 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 fqWgoing pfplication statements are true and correct. <br /> Print Name: t t,t- Qa tr Signature: ` Date: IL <br /> Print Name: Signature: U Date: <br /> Print Name: Signature: Date: <br /> Print Name: Signature: Date: <br /> Print Name: Si nature. Date: <br /> F:\DEVSVC\Planning Application Forms\Revisions of Apprwed Aaions.doc Page 2 of 2 <br /> (Rwised 05-11-09) <br />