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y i <br /> r <br /> Alm-PLICATION - QUARKY EXCAVATION <br /> SAN JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT <br /> FILE NUMBER: <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 /> Property owners or ro7wners of surface rights list all owners <br /> Name: 1ZO(3L Y•I ,$Wg Address: P. 0, RoX ILi29 LA11A)e Phone:209-23(/-/5-M <br /> Signature: Date: <br /> Name: &561r NI, 1910w S2 Address: () , goy 6429 LSP Phone209 .23 r/- )SOO <br /> Signature: , ✓� Date: <br /> Name: Address: Phone: <br /> Signature: Date: <br /> Name: Address: Phone: <br /> Signature: Date: <br /> Name: Address: Phone: <br /> Signature: 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 of mineral rights <br /> Name: r-(2:r14. gQ.�Wtl (Z 1 Address: P.O. (3JX I42 pt ('� vP Phone:zol —23Y-15M <br /> Name: Address: Phone: <br /> Operator <br /> Name: N, B 4;T4 Address: P.O, 1&0X 1 1 2-g LA-rA"19 Phone:Za/-23 <br /> Name: _,� /, Address: Phone: <br /> i <br /> Agenf< f process(person designated by operator as agent for the service process) <br /> Name:Ml(� t. (W'n4 Address: R(D. QaX IVZ9 upff Aofo Phone2ocf- ys'6-0032- <br /> FADEVSVC\Planning Application Forms\ Page 3 of 16 <br /> Quarry Excavation.doc.(Revised 6-03-04) <br />