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Mrd 05/10/2007 14: 27 209468 9324 SJCO PERf,1ITS PAGE 01/02 <br /> %%M APPLICATION FOR MXCROACTMNT P39RMIT <br /> PLry ZN PRINT <br /> Date 4N-7 OFFICE' USE ONLY <br /> To: San. Joaquin County JOB #1: REF # <br /> Departmott of Public Works APX CR• � <br /> LA <br /> EXP. DATE -/S`- 07 <br /> 13.6 ^9 'CAVALID- TO '/S=am? DRIVEWAYS: <br /> (Applicant Name) $(tic <br /> �� /�, ,� �4(0o AR.EA_22 9LY' QUAD _� <br /> vim` -mn c LLA / NVQ" 9S 2-_ TYPE <br /> (Mailing Address) FORMS. <br /> R,e-A-J*r-rM YQ �Q'S 'NOTE <br /> (City, state—zip Code) <br /> � w) Qlti9- oerif-3 <br /> (Area Code - Telephone Number) <br /> Sketch (Detailed plana may be ai braitted) <br /> SGS .e-r'1'6�C.�-c,F�Q Sx�r G3 <br /> TC e undersigned hereby, applies fox. permieg.ion to excavate, cong:truct anal/or <br /> otherwise-encroach•on•.County.Highway Right-o£-Way-ori•the -8ide_-of <br /> approximately too .SQ[�a�_ c__�s�et.file• <br /> of 'htld[.�G �P.�1wnc.�,O�! ��) Tlw/�, (�D(�•�4.4�Gb+�r1+• ,r by 'performiri th© <br /> g <br /> following work (description of:work) . eAG4-!64!M -4ro F�cOdSE �-�1eF� <br /> �n <br /> dim � s�r_.►- rc 'mss Sur¢,rrac� <br /> Work will commence on. or'about, 'S � for approximately <br /> 'alt/O <br /> days. <br /> 7, theundersigned certify that I am the .owner of the respective property, or am <br /> qualified to represeat the owner and agree. to do the woxk described above in <br /> accordance with the rules, regulat-i.ono of San. Joaquin county and subject to <br /> inspection and approval. <br /> Sign t e of Appl ant Title ate <br /> NA1+',I,ISR.P9\P669®L (G/DO1 `�V� <br />