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C11 <br />Map Amendment Application Form <br />------------ <br />Part A <br />SAN JOAQUIN COUNTY PLANNING DIVISION <br />1810 EAST HAZELTON AVENUE <br />STOCKTON, CALIFORNIA 95205 <br />TELEPHONE: (209) 944-3722 <br />(To Be'Filled Out By Applicant) <br />Owner: F n r Ltd Applicant:na„ GIMS <br />ress <br />Address: p_ n Rox 139 AddCity:: <br />_pTB_Bg <br />City: City — <br />State/Zip: ra 9;"278-0Ld State/Zip: Gn oa272-01-44 <br />Phone: 7?A4 — Phone: <br />225- 291 <br />Permit Information (Minor Subdivision or Major Subdivision Application <br />previously approved) <br />Permit Number: n on -7 <br />Date Approved:g-21-8-6- <br />Approved By: <br />Request <br />1, Indicate what condition(s) are proposed to be modified: ^T' ^^ <br />Fl7mina balance of storm drain f f' -1 S <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 />Fngineeri <br />O SIGNATURE <br />I certify under penalty of perjury that I am (check one): <br />�X Legal Property Owner (owner includes partner, trustee, trustor, <br />or corporate officer), <br />IJ Owner's legal agent (attach proof of the owner's consent to file <br />the application), <br />and th t the oregoing is true and correct. <br />2/16/87 <br />w'YYY (Signature) (Date <br />Map Amendment <br />5 - (7/86) <br />