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APPLICATION — REVISIONS OF APPROVED ACTIONS <br /> SAN JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT <br /> FILE NUMBER: <br /> SY77 <br /> THE <br /> APPLICANT PRIOR TOI <br /> TN�G <br /> Appfio <br /> Name: Name: <br /> Address: 2 Address: VVI <br /> CA 34S%C( <br /> Phone, (5-,n) Phone: <br /> Revision to: Map Condifion(s)of Approval Pak- 7CD2-11 <br /> File No: <br /> L Description of the proposed Revisions: <br /> Y,SI9QW- 1&XE&fn IITAE- Tr <br /> 2. State the facts showing the changes in circumstances which make the subject conclitlon(s)no longer appropriate ornecessary. <br /> Div- mo iucz- cv99j&ai- G-oq Ic- (I Ill !WL "�fl r <br /> w �Kl IV <br /> Irria,UX fiE&S1fAf-. UE Fi�-R - g' A1tj-(:z5 . (0m- CuAgt;-,(-- <br /> flzW&-x: uhicc- tl&ya 6C AE, SELFL (Wj,,LTj(Q 'IJMS. <br /> A W' <br /> 14THUR .00VOWN&TWOf <br /> ONLY THE OWNER OF THE PWp &,YOkAW` 9G. "W'Y_ ftl%14,�­0-- <br /> 'A f ilmllb - r <br /> W: ft �OJL AT <br /> 1, the OwnerlAgent 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/Agenrs project. <br /> 1,further,certify under penalty of perjury that I am(check one): <br /> 14 Legal property owner(owner includes partner,trustee, grantor,or corporate officer)of the properly(s)Involved in <br /> this application,or <br /> 'E] Legal agent(attach proof of the owner's consent to the application of the properly?s involved In this application and <br /> have been authorized to file an their behalf.,and that the foregoing a licafkn st.*ments are true and correct. <br /> Print Name: Signature: -1A) — <br /> . la <br /> Print Name: Signature: Date: <br /> Print Name: Signature: Date: <br /> Print Name: Signature: Date: <br /> 0 Pont Name: Si nature: Date: <br /> F:toEVSVWMl ng ApWj.uw Page 2 oft <br /> (%W.d 10 19-0a) <br />