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NOV-28-2009 14:05 G OMATRIX FRESNO • 559 264 7431 P.02i02 <br /> ROUTE; ❑ 0 <br /> FILE NO. <br /> cc FILE NO. <br /> AppLICATIM FOR FNC.RnACRMF.WT HERMIT <br /> S . PRS' T <br /> Date 10 12/00 ^ OFFICE USE ONLY <br /> To= San Joaquin county Job $ REF 8 <br /> Department of Public Work- AM CRv <br /> EXP. DATE <br /> Geomatrix Consultants, Inc. VALID TO DRIVL^WAYS: <br /> (Applicant Name) STREET <br /> AREA QUAD <br /> 2444 Main Street, Suite 215 TYPE <br /> (Mailing Address) FORMS <br /> NOTE <br /> Fresno, CA 93721-2734 <br /> (City, State, zip Code) <br /> (559) 264-2535 <br /> (Area Code - Telephone Number) <br /> Sketch (Detailed plans may be submitted) <br /> The undersigned hereby applies for permission to excavate, construct and/or <br /> otherwise encroach on County Highway Might-or-way on L'hc west side of <br /> Cherry Road approximately _2 0()0- Feet/1M%W north �. <br /> of _East Highway 12 Victor, CA by performing the <br /> following work (description of work) : 4-iich_J19M2L9r <br /> oind arer mgnitoripg ro a dPoth of agoroxiMite l7 So feet below ground <br /> Su ce c le 'on w'll onsist of a traffic-rated vault. <br /> Work will commence on or about for approximately <br /> one days. <br /> 1, the undersigned certify that i am the owner of the respective properly, or am <br /> qualified to represent the owner ana agree CO do the wutk Stscribcd above in <br /> accordance with the rules, regulations of San Joaquin Courcy and subject to <br /> inspection and approval. <br /> c <br /> Signature of Applicant - Title Dacc <br /> TOTAL P.02 <br />