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ana°'n Revisions of Approved Actions Application Form <br /> AM < <br /> SAN JOAQUIN COUNTY Part A <br /> COMMUNITY DEVELOPMENT DEPARTMENT <br /> 1810 EAST HAZELTON AVENUE <br /> STOCKTON, CALIFORNIA 95205 <br /> TELEPHONE: (209 ) 468-3120 <br /> (To Be Filled Out By lypplicant ) <br /> OwnerdCv6c'"�/4 �/�/ c�zrisc S�Appli-,Fant: <br /> Address: 3Z3 Address : <br /> City: " ,cn s City : rl7P� <br /> State/Zip: State/Zip: <br /> Phone: Phone : <br /> Request is for a revision to-ZI/S a- -7/Conditi/on//s of Approval <br /> involving an application for : ��07` �" � ��S� a41/ <br /> File # /v/ s l/�� 7� Date Approved <br /> ly <br /> � Z � 2 <br /> ,,�� / <br /> 1 . De cription o Rev}sions :�)e_v/SGc� 7 /�h�c l/d/ s Ori�� 7LIZ7A,/ 6 <br /> 2 . State the facts showing the change in circumstances which make <br /> the subject condition( s ) of the map no longer appropriate or <br /> necessary. <br /> �L! S 9e —717 /il�4S rce e� �4S <br /> c <br /> 3 . Change inis et d b9/: Appli nt Eng/Rep (fee req <br /> ituired) <br /> County Dept. (Planning, Public Works , etc. (no fee re uire <br /> Planning Commission (no fee required) <br /> E) SIGNATURE T G <br /> I certify under penalty of perjury that I am (check one ) : <br /> Legal Property Owner (owner includes partner, trustee, trustor, <br /> or corporate officer ) , <br /> LJOwner ' s legal agent (attach proof of the owner ' s consent to file <br /> the application ) , <br /> an& that the foregoing is true and correct . <br /> , <br /> Si tureYy (Date ) <br /> � <br /> Revisions of Approved Actions - 5 - (2/87 ) <br />