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ILL OUT BOTH SIDES IF CHECKED HERE <br /> AL `FiORIZP_T?ON FOR E?PLTCP_TION :-'Op Pr�=T(S) <br /> BY OTHER TrM OWNER OR LICENSED CONTRACTOR <br /> TO: San Joaquin County Community Develcpment Department <br /> 1810 E. Hazelton Avenue <br /> Stockton, CA 95205 <br /> Phone (209) 468-3123 <br /> I, as the owner of the property, understand or have been informed <br /> that the application for a Building, Plumbing and/or Electrical <br /> Permit must be signed by the owner of the property, his duly <br /> authorized agent or a licensed contractor. <br /> I am also aware that i may designate a third party, such as a <br /> tenant or person in my enplov, to sign the application for a permit <br /> on my behalf. I understand that the person's only responsibility <br /> or function is to acquire a permit on my behalf. <br /> I am aware that the responsibility for the construction and <br /> compliance to codes and ordinances is entirely mine and I agree to <br /> accept the same. <br /> Therefore, as the owner of the property located at <br /> AUGUSTtj- ST� WooDMIDGE CA . 952- 58 <br /> L (Address/City) c ^, <br /> I do hereby authorize S <br /> �lLb� auSed-(A-� <br /> (Name) <br /> to obtain a �. eS�C��V1fi�Q in my name by affixing <br /> (Type of Per-,,tit) <br /> my name followed by his or her signature on the application for <br /> (Type o` _ r - <br /> OW'NER'S SIGNATURE�L Q <br /> OW'NER'S ADDRESS/CITY Z 7 S m Cir LO I5J" 2-40 <br /> OWNER 'S PHONE NUMB DAT <br />