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of 0 "0a a 8 APPLICATION — REVISIONS OF APPROVED ACTIONS 6 SAN JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT c • • ;P FILE NUMBER : me A �jRio TO BE COMPLETED BY THE APPLICANT PRIOR TO FILING THE APPLICATION Owner Information Applicant Information Name : The Reed Leasing Group Name : Bellino Pit Address : PO Box 3191 Address : PO BOX 4760 Modesto , CA 95353 Modesto , CA 953524760 Phone : ( 209 ) 521 - 7423 Phone : ( 209 ) 524 - 3197 PROJECT DESCRIPTION Proposal Revision to : Map Condition ( s ) of Approval File No : 1 . Description of the proposed Revisions : Please see attachment I . 2 . State the facts showing the changes in circumstances which make the subject condition (s ) no longer appropriate or necessary . Please see attachment I . 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 County arising from the Owner/Agent ' s project . I , further , certify under penalty of perjury that I am ( check one ) : x❑ 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 foregoing application statements are true and correct . Print Name : � IZK.` (2��,i Signature : Date : Print Name : Signature : Date : Print Name : Signature : Date : Print Name : Signature : Date : Print Name : Signature : Date : F :\DEVSVC\Planning Application Forms\Revisions of Approved Actions . doc Page 2 of 2 ( Revised 05- 11 -09 )