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FROM (WED)AUO l 2007 16:20/ST- 10: 19/No. 7613909407 P 2 <br /> 08/01/2007 14 :45 FAX 20948831 SH-COMM-DEV X002/002 <br /> — APPLICATION — REVISIONS OF APPROVED ACTIONS <br /> m SAN JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT <br /> FILE NUMBER - <br /> P"slon <br /> of FZ f I • Fps ) 'pW f Na,. , S'• 1 "t <br /> ',, , I ,� ( PPN ame: rr�� ( �(2( 2 Address: •v, - X lot( <br /> L001 CA; Phone: J;,;:.•vl'ril-! �o: Map Condidon(s)of Approval <br /> I. Description of the proposed Revisions: ( <br /> 2- State the facts showing <br /> gt�the <br /> changes in circumstances which make the subject condition(s)no longer appropriate or necessary. <br /> ,qZfirISO <br /> +/"&J(P-Aaa:a G Ago <br /> (u <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 Owner/Agent's project. <br /> I, further, certify under penalty of perjury that 1 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 applic i of the property's involved in this application and <br /> ave been authorized to file on their behalf., and that the for i a lication statements are true and correct. <br /> Print Name: f`4CAWL- a :A(I K Signature; Date: 7 <br /> Print Name: Signature: Date: <br /> Print Name: Signature: Date: <br /> Print Name: Signature: Date: <br /> Print Name: Si nature: Date: <br /> FAWEV5VC\PIennirq Appllralion FomlelRevlslons Of ApPMved Acllpn5,00C- Paget oft <br /> (Ravlae0 10.10-04) <br />