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