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APPLICA iON — REVISIONS OF AwPROVED ACTIONS SAN JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT C9ZrFOAN\P PA - 0400730 FILE NUMBER: - TO BE COMPLETED BY THE APPLICANT PRIOR TO FILING THE APPLICATION Owner lnfortrtation Applicant Information Name: S(� d S, I f Name: Address: r - Address j Phone: q - -7c)LO Phone: 4 -)a PROJECT DESCRIPTION' Proposal r. Revision to: Map Condition(s)of Approval File No: QFj p t. Description of the proposed Revisions: Or A-b 5 t. + _ r i Tt y 2. State the facts showing the changes in circumstances which make the subject condition(s)no longer appropriate or necessary. +h C)__�xrent- V),01moe ., �t m' Mfininei 0 (D ry-) 1 AUTHORIZATION SIGNATURES ONLY THE OWNER OF THE PROPERTY OR AN AUTHORIZED AGENT MAY FILE AN APPLICATION. 1, the Owner/Agent agree, to defend, indemnify, and hold harmless the County and its agents, officers and employees from any claim, action or proceeding against the Owner/Agent's project. 1, further, certify under penalty of perjury that I am (check one): ❑ Legal property owner(owner includes partner, trustee, grantor,or corporate officer)of the property(s)involved in this application, or ❑ Legal agent(attach proof of the owner's consent to the application of the property's involved in this application and have been authorized to file on their behalf., and that the egoin ap licatio sta ements are true and correct. Print Name: 5 L fesA4 /90y=_ 14C Signature: Date: �9>l3 1149 Print Name: _ 1t?_12P4_gd 20cl?& Sign aiur � y tom, ` Date: .9 - /` I f. Print Name: �-J�o�c y!�t/;-�cr Signature: Dte: 3( pJL Print Name: 3 t� (I �,L�y'(;L an Signature: A Date: Print Name: Si nature: Date: F:0EVSVCtPianning Application FormslRevisions of Approved Actions.doc Page 2 of 2 (Revised 70-1"4)