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MAY-20-2009(WED) 12. 59 P- 002/004 <br /> Hx !late/Time APR?Z3-ZUU9(THU1 U7:55 ZU95781974 P. UUz <br /> 2095781974 M St.,Modesto Ca <br /> 08:55:32 a.m. 04-23-2009 2/2 <br /> APPLICATION FOR RUCROACBMW PERMIT <br /> PLEAB9 PRINT: <br /> nate _ 5d <br /> Ila- . Qoyncz Qsz ONLY <br /> To: San Joaquin County JOB # /-�� REP # <br /> Department of public Works AM CK # <br /> 'A T�_'T I=P. D= U r - <br /> VALM o iS a xs: <br /> (1lpgli aa$t Name) gT <br /> TYPE C <br /> (Mailing Address) FORMS !* , <br /> +��1�7�r�► -4' A °►S , v rr�rE <br /> (City, state, zip Code) <br /> 2��i y��— X11 LA <br /> (Area Code - Telephone Dumber) <br /> Sketch (netaiiled plane may be submitted) <br /> 3 AQ, �r ri' ��� r-'�;►�r,�r` <br /> ` The undersigned hereby applies for permission to excavate,•• constrttct`'and/ar <br /> otherwise encroach-on Ca ty.:gighway-Rightht-of- <br /> t3 3 Pay =.-the. --SES%• -side -of. <br /> of approximately <br /> C:l�-ti r�.�- alxAraximatelYy ^, toet/miam­ <br /> �r-rrt <br /> 4Jw►�tf=. o(, by performing the <br /> following work (description of work) : F pn�a�� q r x * <br /> E7C Cd..tA ti "ra ltt' ��t.►�c 'w�../aG- ar• S�DLI� <br /> F tT � 4titt� . <br /> KOrk will commence on or aboutor <br /> 5 �.'�. a <br /> _-,._� dayu for approximately <br /> I, the undex•signed certify that Y am the owner of the respective property, or am <br /> qualified to represent the owner and agree to do the work descaccOrribed above in <br /> inapeclsnce wit the rules, regulation ' of San Joaquin County and subject to <br /> inspect�.an � apx,roval. <br /> Si �..•�� ati� A�r+t�.]1r6.rr7� �/ Z.� /o) <br /> Saatt a of Applicant - Tit2s <br /> Daae <br /> Tox.rsln=scva� igloo] <br />