Laserfiche WebLink
-lUN-08-2009(MON) 01: 55 P. 002/005 <br /> Kx Uate/Time APK-L3-LUU9VrHUJ 07:55 ZM 781974 K UU2 <br /> 2095781974 M St.,Modesto Ca 08:55:32 a.m. 04-23-2009 212 <br /> APPLICATION FOR EXCROACMRT PERMIT <br /> PLEASE PRINT- <br /> nate - 06 � dO� <br /> QBFICS II92 O1QLY <br /> To.- 'San Joaquin County JOB #-152L>'79` REF # <br /> Department of Public works AGN � # <br /> VALM (a c� TQ T1. <br /> C1 DRx4RFiaY9 <br /> Mppl iaaut Mame) STUFFY . 'Tozbo" LAI_ • <br /> 23-� .y�,t h►� f SaoARM Wboaae.c QMD _NLQ <br /> TYPE CcantGl,cM ''iiaEw SPU�4 PET <br /> (Mailing Address) FORMS ww•- z <br /> 5Tz ckr,'�tJ1 C& �.. NOTE _- <br /> (City, State, Zip Code) <br /> (Area Code - Telephano Eamber) <br /> Sketch (Retailed plans may be submitted) <br /> The undersigned hereby applies for permission to excavate; construct '�tndlor <br /> othsxwise encroach-on county-'19:ighwayRight-of-way on-,�e =W S7'" gide of <br /> appr=Jmate3.y V5 feet/Ani mr-I S Qr:T N <br /> of t-. ' AJ G S:'► ,VZ¢d.:T b I 1.�.1►�'6 E,a(.d , by performing the <br /> fol lowing work (description of work) ; t t a.�s Dti+ W)(S-' J:L&(, ::l <br /> ,"it ArQ OCG 5�1..Lti QtZ rar� iwl.'X(�tt3�+t R Pn�c�. <br /> Work wi11 commence on or about (e 1S �.1 for approximately <br /> days. <br /> I, the undersigned certify that I ant the owner of the respective property, or am <br /> qua]•ified to represent the owner and agree to do the work described above an <br /> accordance wi the rules, regulations of San Jroaquin County and subject to <br /> inspectio pprava1. <br /> �v k.T Q J -o, <br /> Sig=atU=Q of Applicant • Titla <br /> Date <br /> W�SR'�_sallitsCmL teJuat <br />