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r KUI1 •L.HL 11-UMIY I H WH I CK DCRV I Ur- t-Hn PIU. •G177fofel�.. qui • �� ��'�'-+ ��'��' '' •- <br /> Appui=VZON FOR RN'CROAC 15 Y'! <br /> C bQ 0yrzcz USE ONLY <br /> Date , <br /> in County JOS #—q 3 O REF # <br /> To., Sam k7oaqu "N CR ' # <br /> Department of�public Works �/ g". DAT4 8 /5 _ <br /> F\�L.� SNOW , VALID-,-, on '1S- pRZVBiQAYg; <br /> STRSRT <br /> (ApPliCant �Truoctm) ARS �k�tJ " 4QUAD '� ---- <br /> TYPR <br /> (Mailing Address) FORMSNOTE <br /> � <br /> (City, Stayt-e, .Zip+�Code) <br /> (Area Cade - Talaph=6 Number), <br /> Sketch (Detailed plans may be au&dtted) <br /> TY a underaigned hereby aprrlies for permission to.excavate, c AO cC and/or <br /> otherwise•eaaroach-on countyHighway R,.ight-of- Y oa'•the a d4.. <br /> aippxoximately ee <br /> • ' .,. riy'pex£orat�g Che <br /> ollowizlg rk (deacrition f work); <br /> Ar <br /> eto <br /> Work will commence on ox'about , <br /> Por approximately <br /> days. <br /> x, the undersigned certify that I atm the owaer of the reapectivs property, or am <br /> caualified to represent the owner and agree to do the aiork descrx"oed above in , <br /> accordance with the reil. , regu, tja of San C'oaqu� County and subject to <br /> inspection and approval' <br /> signature of Applicant 'title Date <br /> ,wareA,.vsti>K,otcaoz lc/oo> . <br />