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R APPLICATION - REVISIONS OF APPROVED ACTIONS < SAN JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT �iFoaH�p • FILE NUMBER: TO BE COMPLETED BY THE APPLICANT PRIORT O FILING THE APPLICATION Owner Information ' Applicant Information - - - Name: j p s Name: MONTE K. SEIBEL Address: (p Z Co 2- E. ' bee Address: LAND SURVEYOR G4 G Z 221 WEST OAK STREET,SUITE B-2 LODI, CALIFORNIA 95240 Phone: Phone: PHONE(209)334-6523 FAX(209)334-2611 PROJECT DESCRIPTION `'-" Proposal Revision to: Map Condition(s)of Approval File No: PA4 — S Z 0 M. Description of the proposed Revisions: hovG O � Z oWt VVLa s a no e a. res" eti ;Iv u: In si 0 o arsel POPS- 2. a S- 2. State the facts showing the changes in circumstances which make the subject conditions)no longer appropriate or necessary. 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 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 ❑ Legal 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 the bregoing application statements are true and correct. Print Name: cs N r o o C\5 Signature: Date:-/t-1 -"(Y5 Print Name: Signature: Date: Print Name: Signature: Date: Print Name: Signature: Date: Print Name: Signature: Date: F:\DEVSVC\Planning Application Fortes\Revisions of Approved Actions.doc Page 2 of 2 (Revised 10-1"4)