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FROM :CRL 1 i-UHN 1 H WH I LH UEKV i CE F HX NU. ;W4b401 y� Jun. 2( e Wb e4:11rri r Z <br /> APPLICATION FOR EXCROJLCMME M PmunT <br /> OVFYCE USX or1i,Y <br /> Date <br /> gain +708 # d REF # - <br /> TO: San Jon Couxst <br /> y � • # <br /> Department of Pub1�.c works EXP. DATE _4- ., <br /> C1��.1FO N1R \N RT rc C ZkRl VALID i�_a� eco '. �axvsw Ys. <br /> (Applicant Name) STREETtAM <br /> "2Ac.IV QDAD <br /> TYPE <br /> (Mailing Address) Fon <br /> S'ts� � o1 CPQ OTE <br /> �@10 _-Is <br /> N <br /> (city, State, .Zip code) <br /> (ares, Code - Telephone NUWber), <br /> sketch (Detailed plans may be submitted) <br /> The =dersigbed hereby applies for permission to,excavate, Goes ct and/oar <br /> of rwis •encroach•ou, county aighway Right-of•-w$ •on•the \J :::. s -..•o . <br /> approximately -- <br /> of 01 +. ' a. , by'06'r9ovainge . <br /> following work (de$Ctiption of work) : <br /> Worx Will commence 'on or'about Eox approximately <br /> Q days.. <br /> 1, the undersigned oertify that x am the owner of the respective property, or am <br /> qualified to represent the owner and agree to do the walk described above in , <br /> accordance with the rules, regulAtions'of San Joaquin County and subject to <br /> inspection and approval.M-Zk5`"06 <br /> Signattwe of Applicant Title Date <br /> ,aurtft.aswarr®� is/oo1 ' <br /> . 1` <br />