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t <br /> Al?l?LTCATION FOR tXC-ROAC�MWT PERMIT <br /> PLEA= PRINT= <br /> Dade L � q _ ? CE..'USE OgrY' <br /> To: San Joaquin County JGB �_��s.Z 40REF # <br /> Dep t oT' pUh!lic Works PSN C"12 it <br /> ExP. DPTrE' / <br /> DRYVEWAYS: <br /> (Applic t+Name) STRE= / I �. <br /> ARZ .AGI QUAD <br /> C���`�✓� I TYPE-46_q <br /> I �` <br /> (Blailig A+3d�es§) FORMS s5 Gc%11� <br /> (City, State, •Zip.code) <br /> •(Area code.- Telrzphona Numbea)' <br /> Sketch (Detailed plans may be submitted) <br /> 7 15 <br /> The,undersigned hereby applies for permission to excavate, c st tt and/or <br /> otherwise eucr ach on t�'ounty Righway Right-o;f-way on the �� s S� of <br /> agpxaxima.tely �2.� <br /> feet/� o <br /> Of P9=Ll' STOC C_'' by•perform.Zng the <br /> following work (description of work) ! IAsT ,— o F LP''FP L -. <br /> e ��.5 .. ��� tical pti�.rt a <br /> work wijl commenceon or about for approximately <br /> days f • <br /> I, t2le undersigned certify that I am t32,e owner o= t1e• respective property, or Pm <br /> Qualified to represent the owner and agree to do the work described above La <br /> accordance with Cbe "7L", regulati.OAS -of San Joaquin . county and subject. to <br /> imopection and approval. _ <br /> Date- <br /> RMRN MUM TO: <br /> rssra¢.es�Feesr�s (e/00) E <br /> JOS PROCESSM CEW-BW 1 <br /> 4040 VAW LOW <br />� z ,d ME 'ON , •wdiI : < < Booz •�z '�dd `� . <br />