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A,ppLICA,TION FOR UCROACMMXT PEST <br /> VEAS�._PRII�TT: <br /> bate <br /> To: San47oaquin County dab #IN&I / Mr <br /> Dppartmeat of Publi ct works APNCR " # <br /> • VEi� I ZDN L,�L i�CJ;�I`J'A IN`.r Ems. s <br /> VALID. ��3-� W :-D DRT'VE9PAY3: <br /> (Applic@aat Mme) STpmlr .3C�1Tm t1 + <br /> ao- <br /> Mailing Ad&ass) ��• <br /> XOTrk —- -- -- <br /> MAN TECH <br /> (City. State, .Zip Coda) <br /> Z09- 23 9- .3 143 <br /> - f.'xea Code - Telephone Number) <br /> S7cer:ch (Aetai.led plazas may be submitted) <br /> 4e Z6- 3 FDA0AA =: <br /> 741a under-Si,gn,ed hereby.applies for permission to:excavate, 'at and/or <br /> a, . . <br /> nt°I , ,"Qn.. Pacroch•o Co=t. Highway Right-of-W&y..aa•the /IYd,�� eidia bf . <br /> _SHE�TON approximately /Sdfeet/fie T <br /> of E'S C A LVN B F L L6 TA ` by'pexf orening the <br /> f llovimg work (description of. work) : S v8 - S T2UC TU R F W��K <br /> �D.JAGENT T!7 SyELTd/V ROAD ( /itj' Q,Q/VA7-S FEA-rEME-AlT <br /> Mf Y. /N VOL!/ EASTl�O��n/a , LANA P..CSTP/GT//JN <br /> Work will commence on or about .S <br /> 1310 for approximately <br /> _ days. <br /> 1, the wndaxdiigned certify that T am the owner of, the xeepective property, or am <br /> qualified to represaut •the owner and agree to do the work described above in <br /> aaaord=te with the rules, regulations •of San soaqui.n County and subject to <br /> inspection and appz0'va,l. <br /> 10A.R, <br /> 2h 20D8 <br /> siquature of A,pPadcsat TitleJ�, ; Date <br /> VERIZDN NI�TlNO2J'� c"1JG/1ti1�.F�/N( J � ' <br />