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41'H-L3�LUll'9{TIN] U%:55 ZU95731974 F'. UUe/UUd <br /> 2095781974 M P. U U 2 <br /> St,Modesto to <br /> 08:55:32 a.m. 04-23-2009 212 <br /> APPLICATIQM FOR M.JCIzoACWMqT PERMIT <br /> PLLA83 partv*re - <br /> Date t Iq c, tJ <br /> oMc= =3 olgLy <br /> To: -San Joaquin County <br /> Department of public Workv .70B # <br /> APR Cg # — -- <br /> DATV r_,2 <br /> (Applicant Name) VALID /®- -0 M - S-o <br /> sem, S `t arva <br /> Rlra►xa <br /> (moo <br /> (Resiling Address) TDB I * <br /> FORMS <br /> (city, State, zip Code) '�"i's'�• <br /> �a� ��-�► �tip. .- <br /> (Area Coda - 7,1 hall's NEMber) <br /> [ketchtailed plana may he submitted) <br /> 7 A C_'A rL <br /> The undersigned hereby applies for permissionto excavate;•camstzztct`�and/ar <br /> - Otherw3.se, 'encroach-on County. hwa <br /> _ 6L_I L,Lp '�AYw'. - approximately y- gtst-af-Way on"the _... 3 �. -side -of <br /> of �' +PIC�.z.� a fact/+nom �aST <br /> following work (daacription of work) : wr:ri s.� �yN <br /> by Feorming the <br /> �'b S �.cti. Q r4 �C�A�r l ti Ca oC— <br /> S.�S>£ww�.� <br /> hark will commr,+nee <br /> on or 8bout le) <br /> t o <br /> days. - for approximately <br /> I, the undersigned certify that l am the owner of the respective pro ert or am <br /> �lified to represent the owner anti agree to do the P Y' <br /> accordance with the rules, re ulatioms of San Jon work described above in <br /> inspection an aI. 9 4uiu Countyd subject: to <br /> S'gnat a of Applicant - Titla L 4 I.,`1 <br /> Date <br /> +ua"ax.ra\nsaaomn t4/Ool - <br />