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p4u�N y APPLICATION - AGRICULTURAL EXCAVATION <br /> SAN JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT <br /> FILE NUMBER: PA- <br /> AUTHORIZATION SIGNATURES <br /> OWNER, OPERATOR AND APPLICANT INFORMATION'AND SIGNATURES <br /> ONLY THE OWNER OF THE PROPERTY OR AN AUTHORIZED AGENT MAY FILE AN APPLICATION <br /> P�o`.e" owners or owners.of surface rights Uist all owners <br /> Name <br /> mek r C ! Ad ress: I L L96 (�� L h a �� Phone. <br /> Signature: waY�e� nor: -}��s I� �Pe„T ko rr-: Dat <br /> Name: Address: Phone: <br /> Signature: <br /> Date: <br /> Name: Address: Phone: <br /> Signature: <br /> =: �_ <br /> Date: <br /> Name: Address: <br /> Phone: <br /> Signature: <br /> Date: <br /> Name: Address: <br /> Phone: <br /> Signature: <br /> Date: <br /> Note: All Legal owners of the property(s) involved in this project or their legal agents must sign the application thereby <br /> verifying that the statements contained in the application are true and correct. If a legal agent signs the application on <br /> behalf of the property owner, written consent by the owner must accompany the application. <br /> Owners ui orlinie al, ights <br /> Name. 5L Address: <br /> � Phone: � <br /> Name: Address: <br /> Phone: <br /> Operator <br /> Name: Address: /�_ <br /> � 1C v Phone: <br /> Name. Address: o <br /> P ne. 2kyJ'Cy <br /> Agent of process(person designated by operator as agent for the service process) <br /> Name: Address: <br /> Phone: <br /> F\DEVSVC\Planning Application Forms\ <br /> Agrecultural Excavation doc (Revised 8-10-05) Page 4 of 13 <br />