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APPLICATION -- REVISIONS Of APPROVED ACTIONS <br /> ,. .-,irvf l SAN JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT <br /> FILE NUMBER: <br /> �rF ORS <br /> TO BE COMPLETED BY THE APPLICANT PRIOR TO FILING THE APPLICATION <br /> Owner Information Applicant Information <br /> Name: Uwl-r) Yorpicn, eldi Name: .. <br /> Address: �&Z K), t-oJ Address: ��� • -FL -'-Y jF.L— b-� <br /> Phone: (a65 Phare: . <br /> PROJECT DESCRIPTION <br /> Proposal <br /> Revision tb: b l 4 �4Map _ - --- - Condition(s)of Approval- ----- ---- - �_ <br /> File No: <br /> 1. Description of the proposed Revisions: <br /> L C 1 <br /> V, <br /> 2. }State the facts showing the changes in circumstances which.make the subject condition(s)no longer appropriate or necessary. <br /> ,vmC --na <br /> c <br /> l <br /> Aeffco -CCAA if M_ kyffil e_ <br /> AUTHORIZATION SIONATURES <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 employees <br /> from any claim, action or proceeding against the County arising from the Owner/Agent's project. <br /> 1,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 thea plication of the property's involved in this application and <br /> have been authorized to file on their behalf., and that t hof oin e c ion statements are true and correct. <br /> Print Name:-11���� �1 '���11�1 1 Signature: Date: ,l� <br /> Print Name: Signature: Date: <br /> Print Name: Signature. Date: <br /> Print Name: Signature. Date: <br /> Print Name: Signature, Date: <br /> F:OEVSVOPlanning Application FormslRevisions of Approved Actions.doc Page 2 of 2 <br /> (Revised 05-11-09) <br />