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RPR-23-2009(THU) 1 : 03 P. 002/003 <br /> (ts Uatc/Time AP;H-23-Mg(7'HU) U!: 55 2U957bI974 p (102 <br /> 2095781974 M St.,Mod(:sto Ca 08.55:32 a.m. 04-23-2009 <br /> 212 <br /> APPLXMTTON FOR MiCROACM=T pEFMT <br /> PLEASE P��.F. <br /> Date �� 5 <br /> OFBICE IIsg ONLY <br /> TO: -San Coaquin County JOB <br /> Department of Public WorksAFN REFCz # <br /> MCV. DATE � .l�e7 # <br /> VALID •Z •G? To .0 .O DRZVIryPAYS s <br /> •/(� '/f�..��� U1/ plicaatyy NMM) STMMT VjffZ2Jfg4y �QAP){I.0 „ <br /> (MailingAddress) TYPE �-� _u�^` <br /> Q7 - - <br /> Le�es NOTE ` <br /> (city, State, UP Code) <br /> -3r,1 k41-i-1`41'l.n - <br /> (Area Code - Telephone Number) <br /> Sketch (Detailed plans may be emitted) <br /> The undersigned hereby applies for permission to excavate,•• construcL"and/or <br /> -rO <br /> encroach <br /> oa County- <br /> Otherwise R'ghway-Right-of-Way 9n -ta• -•--( E►T 4l <br /> W k'rf� �A-�f...wl �t1L��.t. Side -of <br /> . approximately l►q.of 'T)�ci G • rt ryf(e,e�ta,Y/mPiflYs <br /> iA-S-r <br /> following work (description of work) ; rformin3 <br /> the <br /> 4L IC <br /> 11 <br /> Work will,r�ommence on or about by ay <br /> �l days. for approximately <br /> 2, the undersigned certify that I am the owner of the respective property. or am <br /> qualified to represent the owner and agree to do the work described above in <br /> accordance with they es, regulations of Sae Joaquin County and subject to <br /> inspection and a va _ j <br /> �1Signature o ' Applicant <br /> Daae <br /> eeUrs -C. nrs—, le/ual <br />