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"aurM APPLICA N — REVISIONS OF ROVED ACTIONS c• / ,cFt /r y SAN JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT FILE NUMBER: ^'S7";:F?'(4.5 yr_ y �r`S" v�� ✓ .R u`4 i,d � YF`JlF't%+40 y '�4A ijA 'T �tk' � � �a,�v d by ��a F ce. 3,f T�.c a, "'�.3. ,�,.t•" w "s� �5 f ..,z,f. �?r,.. .:'�`,,. v'. '�.:9G-�'im��r�•sas "'(nt'� Si,`y �' �•�e. 3 J ' ,�.4 r t *� ,� 5 Name: r� 1 .Name: Address: �Sv s A� i ae feD Address: To CX b ri C !25-2 16— Phone: Phone: .3' ,n.,. .c ti• 4 :` __s t': ..,4Tta:y€ tet' .-% 5 �;,x 4 ti� t0.:`` xs,7'fi:�'= '�.. Y_ .1 A._ t fir:. .. "•`!d��vKR..f �.�¢�:y, Revision to: Map Conditions)of Approval File No: 1. Description of the proposed Revisions: SEE ATTACHEDC 2. State the facts showing the changes in circumstances which make the subject condition(s)no longer appropriate or necessary- I , Larry Kundert the owner of properties located at 2579-2613 E. Waterloll Road., have entered into a reciprocal parkinq agreement with the adjacent property known as "New Beginnings Deliverance Center Pentecostal Apostoli Churchrr Incated at 2571 E_ Waterloo Road. That is why conditions no 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. I, further, certify under penalty of perjury that I am (check one): VNLegal 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 bee11n,,authorized to file on their behalf., and that the foregoing application statements are true and correct. Print Name: r Signature: 2 Date: `06 Print Name: Signature: Date: Print Name: Signature: Date: Print Name: _ Signature: Date: Print Name: Signature: Date: F.\DEVSVC\Planning Application Forms\Revisions of Approved Actions.doc Page 2 of 2 (Revised 10-19-04)