Laserfiche WebLink
APR-23-2009(THU)' 13: 17 F'. 002/003 <br /> Hx Uate/Time A?If-li-ZVU9t'1'HUI U7:55 lU4h'/819%4 P. 002 <br /> 2095781974 M St.,Modesto Ca 08:55:32 a.m. 04-23-2oog 212 <br /> PS-e4 oG+��.E's <br /> APPLICATION FOR ENCROACffiKE:NT PERMIT <br /> PLEASE; PRINT <br /> Date 0MCR USE ONLY <br /> To: San Joaquin County JO& # 13aa_'n-3_ k9F # <br /> Department of Public Works ApN # <br /> 7 1 '• bxTs 5•r S: 09 <br /> (Applicant Nam �'= 4"27"d9 To .,��*•IS.'S} 1)RXVXN3Lz8: <br /> STS let�€QLer G <br /> E. f h 1 c. twa v A -Kann _ • <br /> T macro ca ¢ <br /> ' (;!sailing Address) F0RMS <br /> NOTIE <br /> (City, State. Zip Code) <br /> (Area Code - Telephone Bb or) <br /> Sketch (Detailed plane may be submitted) <br /> F 1� 125 . <br /> ` The undersigned hereby applies for permission to excavate;• eanr3tzuet`,�nd/or <br /> otherwise eaczr,ach on Cout7t y•°&ighway-Right-ofl;gay oa the --• 1`i�(�T1� <br /> W T41Fi.(�.t C1,�LCt.t. side of- <br /> Of <br /> f <br /> of C.IDS �.r �{Z,� approximately rLS� � feet/wi-rs _BAST <br /> foxXawing work (description o£ work) : <br /> , �rt f ,L by Performing the <br /> tr v0. M i a�-+:c N L-l✓ tt, <br /> Work will CQ -e ori or shout 27a 9 <br /> L days, for approximately <br /> Z, tr20 undersigned certify that I am the owner of the respective property, or am <br /> With qualified to represent the owner and agree to do the work described above in <br /> accordance les, regulation 6 of San Joaquin County and subject to <br /> inspection and. ro 1_ <br /> Signature of Applicant - xitle <br /> Date <br /> MAs-xk.rslnssamL 14/QOI <br />