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APPLICATION - QUARRY EXCAVATION SAN JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT FILE NUMBER: QX- 9�rFOyz Surface Transportation Assistance Act(STAA)trucks FpNo TAA type trucks,over California Legal length,be used as part of the proposed operation? (if yes,the applicant must provide a letter requesting designation of the proposed facility as an STAA terminal.) AUTHORIZATION SIGNATURES OWNER, OPERATOR AND APPLICANT INFORMATION AND SIGNATURES ONLY THE OWNER OF THE PROPERTY OR AN AUTHORIZED AGENT MAY FILE AN APPLICATION. Pro ert owners or owners of surface rights list all owners Name: '. ;;' i Address: i 1 Phone. 'Signature: Date: Name: t Address: Phone: Signature: Date: Name: Address: Phone: Signature: Date: Name: Address: Phone: Signature: Date: Name: Address: Phone: Signature: Date: Note: All Legal owners of the property(s) involved in this project or their legal agents must sign the application thereby verifying that the statements contained in the application are true and correct. If a legal agent signs the application on behalf of the property owner, written consent by the owner must accompany the application. Owners of mineral rights Name: F' y, Address: ✓nom 1C Ir ' l h/) j Phone: Name: ``,V��` Address: t 3 �? Phone: Operator N62t� 1. !'`1 `z �_ `` ddress: Name: Address: Phone.- Agent of process (person designated by operator as agent for the service process) Namq" Addres one: J•r'7�ci1�?l1�iJ L� v,S2J � FADEVSMPlanning Application Forms\ Page 4 of 19 Quarry Excavation.doc.(Revised 02-03-10)