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t4"'" APPLICATION - REVISIONS OF APPROVED ACTIONS <br /> L;•� SAN JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT <br /> 4 :: . ;;p. FILE NUMBER: - QX "$y-00(0 <br /> �iFO <br /> TO BE COMPLETED BY THE APPLICANT PRIOR TO FILING THE APPLICATION <br /> Owner Information Applicant Information <br /> Name: Teichert Land Company Name: Teichert Aggregates <br /> Address: P.O. Box 13308 Address: P.O.Box 15002 <br /> Sacramento, CA 95813-3308 Sacramento,CA 95851 <br /> Phone: (916)484-3317 Phone: (916)484-3317 <br /> PROJECT DESCRIPTION <br /> Proposal <br /> Revision to:Tracy Rock/Traina West Map 253-12 Condition(s)of Approval#15 <br /> File No: EP/QX-84-10 <br /> 1. Description of the proposed Revisions: <br /> See Attached <br /> 2. State the facts showing the changes in circumstances which make the subject condition(s)no longer appropriate or necessary. <br /> See Attached <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 /> ❑ 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 file on their behalf., and that the foregoing application statements are true and correct. <br /> Print Name: N1rf4Aw E. E6yli- Signature: //i� Date: <br /> Print Name: Signature: Date: <br /> Print Name: Signature: Date: <br /> Print Name: Signature: Date: <br /> Print Name: Signature: Date: <br /> FMEMC\Planning Application Forms\Revisions of Approved Actions.doc Page of <br /> (Revised 05-1109) <br />