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APR-2a-200'9f'FR'I )- 06: 22 F'. UUl%OU3 <br /> Kx !late/Timc Al'1{-Z3-ZUUYI'1'llUI U%:55 GUy57819'/q P. 1102 <br /> 2095781974 M St.,Modesto Ca 08:55:32 a.m. 04-23-2009 2/2 <br /> APPL:[CATION F08 BNCROACSMEN',{' PERMIT <br /> PL <br /> Date _ �^ �. -� Ci <br /> OFHIC]C USE ONLY <br /> TO: San Joaquin County FEt <br /> RggCepartment off' Public Works CR" I S <br /> VALm 4•ZA TO 3•js•o n Ys: <br /> (Applicant Name) STU= Q � <br /> AREA 49MM99OMD A40 <br /> _ �, C�• TYPE A F <br /> Mail <br /> ing Addraas) 1PORMS ----- <br /> S�U NOTE <br /> ('City`* Skate, Zip Coda) <br /> (Area Code - Telephone Number) <br /> Sketch (Dete,iled p1=1z may be submitted) <br /> 1q, Ll <br /> The undersigned 'hereby applies for permission to excavate;•c=gt at`.-und/or <br /> ct:hezwise encroach-on County-in ghway-Right-of_Way on-�t. _..-.3,-,j <br /> —k.1'(t c, Y approximate! IS-7 side of - . . .. - . L­ <br /> of f�J&�� :A% Y - feet/a&•e FA-S�• <br /> %W D Pu �'6t by Performing the <br /> following work (descrigt�.ors of waxk)~ titM a� " ` FL�•t� u • <br /> Work will commence on or about <br /> days. .for approximately <br /> L tht undersigned certify that I am the owner of the respective gropertY. or am <br /> qualified to xepxeserst the Owner and agree to do the work descrra.bed above in <br /> accordance wi the rules, regulations Of SOA ,7oacXuaz� County and subject to <br /> insgecti a ravel. <br /> e.L.rE owc.4 Abrti <br /> sigma Tare of Applicant Title <br /> Date <br />