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08/18/2006 09:31 2094689324 SJCO PERMITS PAGE 01/02 <br /> APPLIdAxxON .FOR EN'CROAaMOM PERT <br /> Date `4IZ3 to „ dF�TCE. II9S rJNfirY <br /> To: San aoaquin County :JO)3 REF' # <br /> Department of public Works APP 0.�9'- 21v- 7--Z- <br /> W. <br /> --Z-W. DATE <br /> \,.. V cn • NAVA SLAC• VALID DRTVRNAY8 <br /> (.Applicant Nanue) S'Z'rtEEZ' �p�P�►� _.__ "" <br /> AREA QUAD <br /> 'TYPE - <br /> -^ <br /> (Mailing Addre o x) FORMS 5-SZwuW_ <br /> 'NO'TE - -- <br /> � cor G5b--4 <br /> (city, State, .Zip Code) _ <br /> cot k 06 <br /> (Area Code - Taleiphone N=ber) -- _- - — <br /> Sketch (Di3tailed pl&ng may be s tt,6d) , <br /> i0o <br /> CIS <br /> T6 undersigned hereby applies for periniaeion to .excavate, construct and/or <br /> otherwise•-en roan� on County Highway Right-of-Way-pa the �: :�'idei..vE . <br /> .+n�►e-4 ec Y1 approximately llu, eet vile fior%k� <br /> of A Aw\ •rA Z 1-1 ELL-t-an 6, a ?eaGon , �pe-cEorming the <br /> following work (a0scription of:woark) : �.�ja.����.�.. n� soy\ �nr�r��. �-a S6.0_- <br /> Work will commence: on or'about• ,4! .305 Zc>bC <br /> for approximately <br /> days., <br /> the .undersignad certify. that I am' the ,owsz'er' of. the xaepocti.'v'e property,. or am <br /> qualified to repieaeut the owner and agree' to do .the 46rk described above in , <br /> accordance with the. rules, xegtaa,t;oQns "of Saiz Joa,cju�n Gouzxty and subject to <br /> inspection and approval. <br /> VV <br /> Je <br /> Signature of Applicant Ti le Data <br />