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FROM :!.AL I FORK I A WATER SERO I CIE FAX NO. :2094640195 Ju 1. 18 200 12: 13Rfl P 4 <br /> AppLXx&Z'IOM FOR M;CRQACMMT PERMIT <br /> Date OFFXCR ME ONLY <br /> To- San o'oagvin o tle COB # 730-7-7 _ RU # <br /> Department of Public Works AP21 Ca # <br /> ;��Oe%MIL A46 <br /> (Applicant N=O) Ste ' <br /> Al- QUAD ^ <br /> TYPE <br /> (Mailing Addrass) FORKS <br /> NOTE <br /> (city, Sbagt�e�,t.Zi©p Code) <br /> (Area Code Telephone Xumber). <br /> Sketch (Detailed plans may be submitted) . <br /> `�'-ria 1\�� �.. .. . .. , • <br /> Ta undersigned hereby,applies for permission to.excavate, construct and/or <br /> otherwise-e2tcxoach•on Coimty Highway itight.o£-Wary•on.the sida •of -• •- . <br /> N\SCS,NVQ pya—, approximately t' ' e <br /> of 7ZAZSjA-% SC"� by ve'xforming the <br /> j <br /> following work (description of work) : <br /> inr Y • <br /> �llola�l 'L'SAC.Q S'L�. - <br /> Work will commence on or-about O CEL., for approximately <br /> l.of� days , <br /> X, the uadersi,gned certify that r am the owner of the respective property, or am <br /> qualified to represent the ow,aer axed agree to do the wiork described above in <br /> accordance with the r s].e�, regulations'of San Joaqu�n County and sub j ect to <br /> inspection and approval. I Qx% -\1`4-b , <br /> 47-\-I -,o- <br /> Signature of Applicaut Title Date <br /> Jgil'iR.47{1ARR8Q6WL f6j001 . <br />