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(10-08-2009) <br /> AUTHORIZED AGENT- IF DIFFERENT FROM PROPERTY OWNER(please print) <br /> Name: F <br /> Mailing Address: by CI rJ C,0 LI K-T -( o fll7 �) ? ;V t )c C.,0 rY )j <br /> Phone: Office: I \9 - - Cr? Home: \"; - C.t.r2)-1 — O - <br /> Fax: Email: )eSso=,'ren@\AtC.SACo0rt-4,- <br /> 1un E2_�V‘c.:€, .c ti • ' <br /> WRITTEN, NOTARIZED,AUTHORIZATION AND CONSENT FROM ALL PROPERTY OWNERS FOR <br /> AUTHORIZED AGENT TO ACT ON THEIR BEHALF <br /> NOTE: ALL CORRESPONDENCE REGARDING THIS APPLICATION WILL BE ADDRESSED TO THE <br /> AUTHORIZED AGENT/REPRESENTATIVE UNLESS OTHERWISE REQUESTED. <br /> SURVEYOR (please print) <br /> Name: Jf✓I-FPi�y O i i`E.f,t <br /> Mailing Address: '-1 C� l c�� �F::� .( .�: -_ 1 't - <br /> Phone: Office: -" ' Home: <br /> Fax: Email �,�- oY )en�h 5‘n , rY <br /> lur,dser'ifte� - �r,'cf <br /> ENGINEER(please print) <br /> Name: <br /> Mailing Address: <br /> Phone: Office: Home: <br /> Fax: Email: <br /> PROPERTY INFORMATION <br /> Legal Description of Property: <br /> ❑ If Subdivision, name: <br /> Lot Block Filing Tract <br /> ❑ If Metes and Bounds:Section Township Range OR Attach a legal <br /> description and survey depicting the property boundary. <br /> • f <br /> If Mining Claim(s), include name(s)and Mineral Survey Number(s): C(''MC Z S <br /> Lo4,,,3 No. ; �i �� Lc-)Am. <br /> CY'nC 27251 E3 t=- _oD� i�lc,o 1 C't-\C. ? !L�SZ'�INA\C,K—r 4 <br /> t_ot7p &Iv. t <br /> Street Address: �oRs,s-r1'. '�' off%2-7'3 ^—, s 9 12 1 12S <br /> t <br /> Assessor's Tax Parcel Identification No(s)(PID): 1J ? ;�' ;_ ,1 (7,-1 M. <br /> NOTE: IF LESS THAN THE ENTIRE PROPERTY IS THE SUBJECT OF THIS APPLICATION,ALSO <br /> ATTACH A LEGAL DESCRIPTION OF THAT PORTION AFFECTED. <br /> Page 2 of 4 <br />