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APPLICATION - ROAD NAME CHANGE (PUBLIC) <br /> SAN JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT <br /> rFo. FILE NUMBER: RN- PA 1300196 <br /> TO BE COMPLETED BY THE APPLICANT PRIOR TO FILING THE APPLICATION <br /> Applicant Information <br /> Name:57 COUNTY PUBI.IL Wlg*-'S CIIIRrSTlAm [,ER--VALITE'S <br /> Address: j>FSj& N E U E I N - R L & <br /> Phone: 2-04- of 3 — —lgS'7 <br /> PROJECT DESCRIPTION <br /> Proposal <br /> Existing Road Name: S r.4?E K:r q9 E. FU A/ <br /> Proposed Road Name: "INIMILMANCE WAV' et %% IVEKLA PL-ACIE <br /> Location: P-V IED AW b- ttIc,#WAY C19 <br /> Reason for Change: 5E6 /cTTA ED P.4 A/A /LAA Ps <br /> APPLICANT SIGNATURE <br /> PUISL IC WO9,K.S <br /> Print Name:C.WKISTIW CEKVA 5 Signature:r .. C-Gr,. Date: 11- 4 - 13 <br /> Print Name: Signature: Date: <br /> Print Name: Signature: Date: <br /> Print Name: Signature: Date: <br /> Print Name: Signature: Date: <br /> Print Names Signature: Date: <br /> FADEVSVC\Planning Appiica6on Fonm\Road Name Change(Public).doc Page 2 of 2 <br /> .(Revised 6 02-04) <br />