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,APPLICATION FOR EXCROAMONT PIRNIT <br /> gr LA&PRTNT:- <br /> Date ` T/D 6 . OFFICS'. USE ONLY <br /> To: 9an, Joaquin County .,JOB # REF <br /> Department of Public Works APN + # <br /> EXP. DA <br /> Grc,►;cy. _ VALID= j <br /> DRIRE9 X :; <br /> liaaat Name) sTRE$T <br /> ( � <br /> AREA <br /> S /V• TYPIS <br /> mai ing Address) FORMS <br /> � L <br /> L�/�/n•�l ei'c�k �14- 9�slf8 NOT" <br /> (City, abate, .Zip Code) <br /> (Area Code - 'Velephone Number)• <br /> Sketch (Do-tailed plans nmay be aubititted) , <br /> C_ V y�a� <br /> :A co <br /> The undersigned hereby applies for permission to .axaavate, construct and/or <br /> otherwise-encroach•on••CaLMtY--Highway &.ight-of-Way•'on they . : alde_bf - <br /> �G�r approximately o• feet/mile <br /> of ., <br /> by"Paw the <br /> follo in�g work (description of, work) : r t4IDA° �� P�^✓a►� ��u''vC.� fe d{v� <br /> t u Q _ • , <br /> Work will commence on. or'abort )III I n6 for approximately <br /> days. <br /> z', the ,undersigned. certify that I am the owner of the respective property,, or am <br /> qualified to represent the owner and' agree to do .the work described above in , <br /> accordance with' the rules, regulations 'of San Joaquin County and subject' to <br /> inspection an proval. <br /> Signatu a Appli Tit-2h <br /> ;I <br />