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Revisions of Approved Actions Application Form <br /> •r.�_�ep:� SAN JOAQUIN COUNTY PLANNING DIVISION Part A <br /> 1810 EAST HAZELTON AVENUE <br /> STOCKTON, CALIFORNIA 95205 <br /> TELEPHONE: ( 209 ) 968-3120 <br /> (To Be Filled Out By Applicant) <br /> Owner : U(I.LIF^ $ !SbP1A 3AkR Applicant: SIaME. <br /> Address: (1-1+{0To4t AY rDLOWY 2D . Address : <br /> City: o i City: <br /> State/Zip: CLj 9,5-aD State/Zip: <br /> Phone IS C Phone : <br /> Request is for a revision to: �\ Map Condition/s of Approval <br /> involving an application for : Itrr�,J�L Pf/rM1Y <br /> File # lip $g- 112. Date Approved Oo'1$g <br /> 1. Description of Revisions:' fad LdlgF{ -v-n F� 27_C`r A rIIE: i`l MoDULAZ <br /> Qp,pj4 C)4 A i�)1FFE2f-(T -r-t4r <br /> SAr.^,E_ PA 2CE(�t_�,(STI<./i0 OF US 1C��kF� �s1�l �J�CLn1 <br /> AcUZ1r l AL1 L.Y A2oPc�ssn <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 /> Fl >=2 Nl EL �1 AD �i E 2 M� <br /> IJE Foc�,So �r Cb�( J�rz sl�,� C�g -R2bT4 i z lTl q <br /> EIS MbDULAlI 43Fa2N �1R5 �Oc�aD `aO Of Aa A�TdK'DAeW,7 At77 ;�nvE . <br /> 3 . Change initiated by:�Applicant Eng/Rep (fee required) <br /> County Dept. (Planning, Public Works , etc. (no fee required) <br /> Planning Commission (no fee required) <br /> ❑ SIGNATURE <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 /> L] Owner ' s legal agent (attach proof of the owner 's consent to file <br /> the application ) , <br /> and tha the foregoing is true and correct . <br /> (Signature (Date ) <br /> Revisions of Approved Actions - 5 - (2/87 ) <br />