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r i ' APPLICATION - REVISIONS OF APPROVED ACTIONS NQ. SAN JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPAR MENT P ' FILE NUMBER: TO BE COMPLETED BY THE APPLICANT PRIOR TO FILING THE APPLICATION Owner Information Applicant Information Name: Southwinds Church Name: Jay Mills Address: 13400 West Middle Road, Tracy, CA Address: 13400 West Middle Road, Tracy, CA 95304 95304 Phone: 209-835-4673 Phone: 209-835-4673 PROJECT DESCRIPTION Proposal Revision to: Use Permit Mapparcel B as per map fled May Condition(s)of Approval File No: UP-96-000213, 1976 in volume 2 of.parcel maps,page 195 San Joaquin County Records 1. Description of the proposed Revisions: Requesting an extension to the expiration date noted on the Appro ed Actions Application No. UP-96-0002 (APN: 212-040-02) dated September 17th, 2013 2. State the facts showing the changes in circumstances which make the subject condition(s)no longer appropriate of necessary. The project master site plan is currently being redesigned, a two (2)year extension is necessary in order to resubmit to the San Joaquin County Community Development Department and Building Department. The current expiration dale on the application will become effective on June 17, 2016. The Client would like to extend the expiration date of the Approved Actions Application by years. The new xpiration date proposed is June 17th, 203-} AUTHORIZATION SIGNATURES ONLY THE OWNER OF THE PROPERTY OR AN AUTHORIZED AGENT MAY FILE AN APPLIC,k,TION. 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)invol ed in this application,or ❑x Legal agent(attach proof of the owner's consent to the application of the property's involved in this applicat on and have been authorized to file on their behalf., and that the foregoing application statements are true and cor ect. Print Name: Jay Mills Signature: Date: Y12 1/6 Print Name: Signature: Date: Print Name: Signature: Date: Print Name: Signature: Date: Print Name: Signature: Date: FADEVSVQPianning Application Forms\Revislons of Approved Actions.doc Page 2 of 2 (Revised 10-19-04)