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111- 06 (+ os' s <br /> ? P4 APPLICATION - REVISIONS OF APPROVED ACTIONS <br /> r' <br /> a c SAN JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT <br /> . i•, FILE NUMBER: - - <br /> tiK6k�~ <br /> TO BE COMPLETED BY THE APPLICANT PRIOR TO FILING THE APPLICATION <br /> Owner Information Applicant Information <br /> Name: \ I k v A N Name: 1 t \k)L tkFU <br /> Address: L1. 1( jMt \ Address: e \QeQZ�jQ\\DCJ�E <br /> Phone: (p— Phone: $ — <br /> PROJECT DESCRIPTION <br /> Proposal <br /> Revision to: j� eT p Condition(s)of Approval <br /> File No: <br /> 1. Description of the proposed Revisions: <br /> Z. VNO <br /> 2. State the facts showing the changes in circumstances which make the subject condition(s)no longer appropriate or necessary. <br /> v� G�t�� \ U Ltd L I�UJi llL <br /> l t <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 /> 0'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 the application of the property's involved in this application and <br /> have been authorized to fi'le1 on their behalf., and that the foregoing .I' Ion statements are true and correct. <br /> Iuth <br /> Print Name: , gnature: Date: (� <br /> Print Name: Signature: Date: <br /> Print Name. Signature: Date: <br /> Print Name: Signature: Date: <br /> Print Name: Signature: Date: <br /> F?DEVSVCUPlanning Application FormsVRevisions of Approved ActionsAm Page 2 of 2 <br /> (Revised 05-11-09) <br />