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II <br />CG.- AUNITY DEVELOPMENT DEPARTMtNT iD ) =LJ9 <br />1810 E. HAZELTON AVE SAN JOAQUIN COUNTY � I�r <br />STOCKTON, CA 95205 OCT ' 2 2003 <br />(209) 468-3380 <br />FIRE PERMIT APPLICATION - FP-0300195 ENVIRONMENT HEALTH <br />PERMIT/SERVICES <br />Fire Department: WOODBRIDGE Date: 06-06-2003 <br />Location :12145 N DE VRIES RD LODI <br />Cross Street <br />Application is hereby made for a PERMIT as required by the San Joaquin County Bureau of Fire Prevention and the <br />Jniform Fire Code. <br />TOTAL AMOUNT DUE $95.00 <br />knicle/Section: <br />105BF36 REMOVE UG TKS/INSTALL UG $95.00 <br />$0.00 <br />$0.00 <br />$0.00 <br />$0.00 <br />$0.00 <br />Use the space below if the above information is incorrect or incomplete. <br />)WNER'S NAME & ADDRESS <br />MGDON PROPERTIES <br />8514 E LONE TREE RD <br />iSCALON CA <br />:ONTRACTOR'S NAME & ADDRESS <br />APPLICANT'S NAME & ADDRESS <br />D & S DRAG LINE <br />540 F ST <br />LOS BANOS, CA 93635 <br />ENGINEER'S NAME & ADDRESS <br />have read the above application and know the contents thereof: the same is true and correct. <br />Applicant's <br />:ontactPerson: �!<C_ Z���'n Signature <br />:ontact Phone <br />