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P4230006 2 1= ET TER OF AUTHORIZATION APPLICATION FOR ZONING/ LAND USE ENTITLEMENTS Site !Number: CA�7321 Property Address : 25230 HWY 12 RD, CLEMENTS, CA 95227 - 7157 Assessor's Parcel Number: 023 - 220350 -000 /We, the owner(s ) of the above described property, authorize Vertical Bridge, and /or Assurance Realty, LLC . dba Assurance Development, their employees, representatives, agents , and/or consultants, to act as an agent on my/ our behalf for the sole purpose of consummating any building and land - use permit applications, or any other entitlements necessary for the purpose of constructing and operating a wireless telecommunications facility . I /We understand that any application may be denied , modified , or approved with conditions , and that such conditions or modifications must be complied with prior to issuance of building permits . I /We further understand that signing of this authorization ' n no way creates an obligation of any kind . Signature of Property Owner ( s ) : Date / l q Date : 1 ! /2, ACKNOWLEDGMENT A notary public or other officer completing this certificate verifies only the identity of the individual who signed the document to which this certificate is attached , and not the truthfulness , accuracy, or validity of that document . State of California County of S'A N Jm p o I L) ) On � q � � before me , l t�1R P:�AZft2 , —oa ( insert name and title of the officer) personally appeared Soj> C[ -c 6ECAKlo`T :r,2iGES a,�� NN ► E G � ,SfPia) u TJ who proved to me on the basis of satisfactory evidence to be the person@ whose narne@Ware subscribed to the within instrument and acknowledged to me that he/ahe/they executed the same in hi&Ahef/their authorized capacit ie , and that by his/her/their signaturEo on the instrument the person) or the entity upon behalf of which the persoro acted , executed the instrument . I certify under PENALTY OF PERJURY under the laws of the State of California that the foregoing paragraph is true and correct . ••.N**#"#"W._ ! !• §N •- ZAZ y=s'•• ••• • • •: omission # 2339451 • County of San doaquin WITNESS my hand and official seal . C4*Wnla - Notary Public ; Signature ( Seal )