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From: 2094689324 Page: 1/1 Date: 1/7/2008 9:28:36 AM <br /> Ar,PL16A ION FOR XNCROALCEMNT FIMMIT <br /> Date ! ` ( � OFFICE USE ONLY <br /> To; San. Joaquin County soi3 # ZZ2Z)'� REF #� <br /> Department of LPtLbLiC Works APN CR # <br /> EXP. DATE <br /> j� VALOID ' L TO DFIV%WAYS: <br /> (Applicant Name) STREET �57 v&Yf MY 1-1: * _ <br /> (Mailing Address) FQRMS �L✓%J __-- _ <br /> NOTE <br /> (City, state, 'Zip Code) <br /> i G '1 / 7 <br /> - Z--j 5-4 <br /> (,Asea Code - Telaphozi® Number) <br /> sketch (Detailed plans may be submitted) <br /> POs#-ir F � Oie 76 oate pPg- <br /> A L 5' <br /> Phone M // <br /> PP Fax# X# <br /> The undersigned hereby applies for permission to excavate, cons,• xucl and/or <br /> othez�^;,�,se encxoa o Cjunty Highway.Right-of-Way- on-th ,�•e I side of <br /> t,). Z) �'+ - by Npexforming the <br /> following work (description of work) : <br /> Work 11 commence on, or about: � � for approximately <br /> l w days. <br /> I, the undersigned certify that 1 am the owner of the respective property, or am <br /> qualified to represent: the owner and agree to do the oiorl< described above in <br /> accordance with th r les', regulations of Sari Joaquin County and subject to <br /> inepection and app 4 1. <br /> Ems j l � - t:� ,3 <br /> Signature of Applicant - Title A Date <br /> MJ�81'SA.a^.1f339CtSL 15/001 <br /> li <br /> This fax was received by GFI FAXmaker fax server. For more information,visit: hfp://www.gfi.com <br />