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cl) APPLICAT�JN - REVISIONS OF AF,-ROVED ACTIONS SAN JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT FILE NUMBER: - TO BE COMPLETED BY THE APPLICANT PRIOR TO FILING THE APPLICATION U Name: Owner Information Horizon Christian ip ApPlicantlnformati Fellowshon Name: Addres4: 10702 N. Lower Sacramento Road Gl Address: Stockton, CA 95210 Phone: (209)478-4789 Phone: O� ^ PROJECT DESCRIPTION Proposal Revision to: Map Conditions)of Approval File No: UPOO-0021 1. Description of the proposed Revisions: Design and construction of Phase III of our project as noted in the original use perm t approva . 2. State the facts showing the changes in circumstances which make the subject condition(s)no longer appropriate or necessary. Ori inal timin of construction has aged. It is now determined to be an additional five years, due to cost over runs on Phase I & II, as well as lack o un s to procee imme is e y wirn Fusee III. 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 fore a at' tatem is are true and correct. Print Name: H. T PRny ttinatre Signature: Date: 811/06 PdntName: Joe Dague Signature: - Date: 8/1/06 Print Name: Signatu : Date: Print Name: Signature: Date: Print Name: Signature Date: F\DEVSVC\Planning Application Forms\Revisions of Approved Actions.doc Page 2 of 2 (Revised 10.19-04)