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<br /> APPLICATION - REVISIONS OF APPROVED ACTIONS
<br /> SAN JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT
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<br /> Name: P cif • Nsme n r l ire 1ess Pto.
<br /> Address: P 0. Box 175 , Address:7488 Shoreline Dr. B-1
<br /> Victor, CA. 95253 Stockton, CA. 95219
<br /> Phone: _ _ Phone:
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<br /> Revision to: SA-9 7-2 6 Map Condition/s of Approval
<br /> File No:
<br /> 1. Description of proposed Revisions: Original intent was to apply for 100 ' mono of
<br /> Error on application had 100 ' monopole on site plan and 70 ' mono of
<br /> on application.
<br /> 2. State the facts showing the changes in circumstances which make the subject conditions no longer aro riate or necessary.
<br /> for proper radio
<br /> frequency propagation.
<br /> i
<br /> ATHtRfZAT10N.51GNaTC1RES '
<br /> ONLY THE OVltN :. . , .PaOPE)2`I:: w: M - AG ENT.MAY FILE AN :IkPPUCATION.
<br /> I, the Owner/Agent agree,to defend, indemnity,and hold harmless the County and its agents, officers and
<br /> employees from any claim,action or proceeding against 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, trustor, or corporate officer) of the
<br /> property(s) involved In this application,or
<br /> Legal agent(attach proof of the owner's consent to the application of the property's
<br /> Involved in this application and have been authorized to file on their behalf.,and that the
<br /> foregoing application statements are true and correct
<br /> Print Name: Philip C. Hawt i n Signature: Date: 8-1 -9 7
<br /> Print Name: Signature: Date:
<br /> Print Name: Signature: _ Date:
<br /> Print Name: Signature: Date:
<br /> Print Name: Signature: Date:
<br /> -2-
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