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• APPL`ICAT("')N - REVISIONS OF A 'ROVED ACTIONS <br /> SAN JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT <br /> FILE NUMBER: - <br /> FName-:'�(Granite <br /> Construction Company Name: Jeff Otto <br /> Address: P.O. Box 151 Addre :P.O. Box 151 <br /> Stockton CA 95201 Stockton, CA 95201 <br /> Phone: 209 982-4750 Phone: (209) 234-3559 <br /> i'•u' ,� s. _ res _ <br /> P,, s Yi��ti•. _1�:LA. .LIlr+4,� •k.t <br /> .�,j.i.. i ..l;;is>`����y _�..�i. �,j .•�,,�k�..j'A'-i:1;�TC�''•Y� `n' +7� r�':. v�`1r: � i r - _ _ �k��.`:�-;..?!. <br /> Revision to: Quar Excavation Permit Map Conditions)of Approval 1-z <br /> FHe No: QX-94-1 <br /> 1. Descdpfion of the.proposed Revisions: <br /> See Attached <br /> 2. State the fads stowing the changes in circumstances which make the sub condibon s no longer to r <br /> 1� ( ) 9 pQroprra a necessary. <br /> See Attached <br /> A UTHORIZATION'SIGNATURES <br /> ONLY THE OWNER OF THE PROPERTY OR AN AUTHORUED.AQENT 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 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 sopfic-atton statements are true and correct. <br /> Print Name: Jeff Otto, Granite Construct42 Co. Signature: Date. 10/28/04 <br /> Print Name: Signature: Date: <br /> Print Name: Signature: Date: <br /> Print Flame: Signature: Date: <br /> Print Name: Signature: Date: <br /> F:+DEVSVVPiannfnp Appka§m Form %RevWw&of AppnwW Adlons.doc Page 2 of 2 <br /> -(revised 10-19-04) <br />