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I-KUI'I .I-HL 1 r UKIV 1 H WH I CK bCKV 11,C r HR I`IU. •G✓J7°+O'+eJ17J i-lar e� eer�� e!e•Ali <br /> APPY,SCAxI4N VCR �CRdAG� PERMIT <br /> r,EAS$ PRINT <br /> Date C"k "' OFFXC8 USE ONLY <br /> To. San oaquia county ,70R -7.30 ' # - <br /> Deparfinexxt of Publie Works APNSXpcls <br /> CN\ SOF, h'NN R --A Z \14 VAL To � 02.: DRZVWAY•g:, <br /> (ApplicamC Name) STRY:ET a „ e uizct-r- AV4MQV <br /> - <br /> trading Address) row <br /> •��pC��c0�1 � �� �c3,�J� NOT>~ <br /> ll�--s�.`•Z�.g cede) <br /> -233 <br /> (,Area Code - Telephone K=ber) <br /> sketch (Detailed plans may be submitted) <br /> The undersigned hereby applies for permission to,OXCaVate, construct =d/or G4kh l <br /> othe aeacr on Coutttsy-Righwap fight-of-wa •os•thaye—st..._ €�iu.b - - <br /> approximately �� <br /> of U Esa X C50 by pet-90=M49 the . <br /> following work (description of worki <br /> NP <br /> Work will commteace on or'abort fo approximate]y <br /> V _ days. <br /> I, the undersigned cerrt££y that x am tkte owner,of the respective property, or am <br /> qualified to represent the owner and agree' to do the woxk described above is , <br /> accordance with the rules, >regaations1'of San 4roaqu�n county and subject Co <br /> inspection and approval.4Z-a3-0-1 ` <br /> � � V <br /> si.gziattixza of Applicaeat - Tf.cla Data <br /> �o�s•�s1r.p8wtakcrpoL tc/oo1 , <br /> ' i <br />