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waw. 12. 2005. 7:47AMAx. zGl"DY N KAV ILOS LLC uacFtAy & soups No. 3923P. 3/3, I <br /> it.♦ar . _ter >u-MA 50'1/100% / e��v ..x•iuYtrr+ ix' - . <br /> SAN JOAQ�COT.1NTY CW11'-0SMEN tA.L$SALT»DEZ• RTM 1fr <br /> SERVICE REQUF-ST ,cs� 0 <br /> FACILITY{0 it <br /> Type of suslnose of Property <br /> if <br /> CNVNER/OPERATOR A/it <br /> / j {( 1 J <br /> Fr�mfIAME �!{� 9. <br /> s DRESS - �LAA),y/ <br /> 00 6 te.� Oil <br /> NOME Or MA"Ari ADDRQBS (I1 DII{aront from 9110 Adareaa) STAT➢ <br /> crry LAND USE APPUC "10 <br /> rn. APNa <br /> P110N6 in Eim lADaitDM C.oRR <br /> ( I £%t. <br /> PNONc fR �sTQR <br /> CONTRACTOR/ SERVICE PX-'e CnEOK If 93 ut1!' AP01100 <br /> �r� Al, 1��+%SDs p <br /> �rjQUESTOR P <br /> 1 � <br /> BUSIN69e NAME AJ <br /> Nous or MAIL•,;ADDR4s3 ` 0/ L4O sTTr <br /> e lSator DF ARtJlOr�ed rgppt of arrM <br /> CITY O or baslpees owner, p e,eesociated Witt.this proJ�01 <br /> J, the nndersi�ed proPert9 tT isivel ABN f>io ub cb�H <br /> cct eci5c ENwD�T�'1eN- IiPA <br /> a�Owle ill ,tar 811 eitc Ae or prod ep n d on thil form• a f` a'il SAT R <br /> Witt be billed fi me of 1nY htielne•a as Ode erfolmod ,be done ift J 1 <br /> rctivity r that{!1c work�' P , I <br /> that I have prepared appii I, 5". u <br /> L•two certify ST d <br /> COur+'n'Ordinancr Cadet,Stand DATC: <br /> A"'LICANT'S SIGNA."k'J": At Ht - <br /> 11NA ADrP� Or'Ittt+ ti(1r <br /> Oe Inn to sign la rageiKa bca�at f <br /> p�tgrrv18ve1ffA O,1rA rtoI the proof of Wn6orlZal arator cr die property;Y <br /> (fAPpL![•a O .When applJeable,J.,Ie a.vner or oy Onviro,tmmt►Vsitc ae•os90ol <br /> u t110 1c1eNe of an7' *nd sIl reE.tlte, g1locimieal data aad/ox <br /> above site addrma, <br /> he, ro�thori <br /> TM�NyD134 of Any lits�LT'1 D 4f A' Nt w 900n r1 it is ava9leblc and at the sanrc doe it <br /> mfomlation to rho SAN JOnQVIN�IJN <br /> provided to me of my fepmflon e <br /> �jiaR <br /> TYPE <br /> J10E iZEalF3�i35: O // .RECEIVED <br /> a DF 9ER / /- �! V r /ke)perOG(�I I1F3��E�;.1 <br /> ca�MVR . y /` peb,,t Kai p . I _ Esca JAN 2 1 2005 <br /> j lX,/�t�frtx a �cch� k5 ly1Z41, <br /> SAN JOAQUIN COUNpT4FY-- <br /> Ooe� <br /> Date seMo•cQmPleted (U alroeay DemPlat•di: crl Peym,em Done I 2i D S <br /> Amount Psle (o o _c5 D <br /> FeD Amount: / Resolved 9Y �L <br /> Invoice fl cheek# ,_- <br /> PeymentTyPe <br /> Pam► <br /> 9R FORM lOoMe dl <br /> E)iD AO-02.Oab PostiN Pax Note 7571 ml(Z <br /> REVISED 11/1712003 To P'm <br /> eo. c <br /> C�JDeQ <br /> ons � PftOnON <br /> F•x N 4� 0 rax• , 4 � <br />