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APPLICATION - REVISIONS OF APPROVED ACTIONS 2' s i SAN JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT ;p FILE NUMBER: - - TO BE COMPLETED BY THE APPLICANT PRIOR TO FILING THE APPLICATION Owner Information Applicant Information Name: Gerald Ford Name: Dillon & Murphy, c/o Joe Murphy Address: 22800 E. Milton Rd. Address: P.O. Box 2180 Linden, CA 95236 Lodi, CA 95241 Phone: Phone: 209-334-6613 PROJECT DESCRIPTION Proposal Revision to: PA-03-648 Map Condition(s)of Approval File No: 1. Description of the proposed Revisions: Revise the Tentative Map to its current confi uration. 2. State the facts showing the changes in circumstances which make the subject condition(s)no longer appropriate or necessary. I decided to slightly revise the Tentative Map as approved. See enclosed. 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. 1, 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 foregoing appliation stat ments are true and correct. Print Name: Gerald Ford Signature: Date: 5/2/05 Print Name: Signature: Date: Print Name: Signature: Date: Print Name: Signature: Date: Print Name: Signature: Date: Fr 1DEVSVDPlanning Application Forms\Revisions of Approved Actions.doc Page 2 of 2 (Revised 10-19-04)