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U <br /> ° a . . . N. APPLICATION — REVISIONS OF APPROVED ACTIONS <br /> 4. c°� <br /> 0 SAN JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT <br /> � • . • _ _ _ ��. FILE NUMBER : <br /> - oo � <br /> � L � F012a <br /> TO BE COMPLETED BY THE APPLICANT PRIOR TO FILING THE APPLICATION <br /> Owner Information Applicant Information <br /> Name : � Name : ` AJ ! Q �� vw1w <br /> Address : 1 � U � Ij(, ' G �/� tj 6ole4i f�&« t� Address : (� 70 6 / • &L (k roewlb <br /> 6Z::: 413t* Gam, CIS d Lk) St rzpj C^ 9:571 5 Z6) . <br /> Phone : SCJ G11 Phone : �l ) � l <br /> PROJECT DESCRIPTION <br /> Proposal <br /> Revision to : bjFZ Or V & j*T Map Condition (s ) of Approval <br /> File No : �t <br /> 1 . Description of the proposed Revisions : TL�i �a L) &� d ' J Gi d L v Cir' c� l.tic� <br /> tu <br /> 2 . State the facts showing the changes in circumstances which make the subject condition ( s ) no longer appropriate or necessary . <br /> lS �1tL AA) (bem l !� � t� e 4�J� 5 S is �7 r i` <br /> 6i tjn OA e Ke <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 /> egal 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 theyforegoing application statements are true and correct . <br /> Print Name : I'4' 1 �-J Signature : Date : <br /> Print Name : Signature : Date : <br /> Print Name : Signature : Date : <br /> Print Name : Signature : Date : <br /> Print Name : Signature : Date : <br /> F :\DEVSVC\Planning Application Forms\Revisions of Approved Actions . doc Page 2 of 2 <br /> ( Revised 05- 1 1 -09 ) <br />