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F k'I 1 :�-:HL 1 F IUHN 1 H WH I bk :iEkV I C;b F HX NU. :2Uy4b401 J5 <br /> gun. :�b �uUr uz.lbt'I'I r <br /> APPLICATION FOR ==oAC VT PgMT <br /> • �r��.s�x�: . <br /> DaCa...- _ ...._.pPPx(R.1MR..MY__._.... ' <br /> To: San Joaquin County sob # '736?7 R� # <br /> Department of Public! Works 1VNVALID <br /> M. DATE <br /> lea�... �. DRarsrs=xs: <br /> (Applicant Ramie) STMMT LA&A14 ,r <br /> .154� •��.�10�"�C ��C�3 ' MU:) ....� <br /> o <br /> Oiling Addross) FORMS .Z <br /> S�toc�l. .o Cts A5 a0 3 xox <br /> (City, sbata, .rip Code,,. <br /> (Area Coda - Telephone hex), <br /> Sketch (Detailed 6laas''may be submitted) , <br /> • <br /> The undersigned hereby.applies for permission to-excavate, Const et axed/or <br /> o e^encroach,on County Righway Right-of-XftY-.o7t 81 <br /> approximately f mid <br /> of .. • .:. . <br /> 01 wing work (desGraptioaa of work) by Vext'oxming the <br /> ;, -- • <br /> Work 41L comaeace on or about <br /> for approximately <br /> ---- days. •, • <br /> I, toe uadersxgaed certify that I am the owner of the respeeti.ve property, or am <br /> qualified to represent the owner and agree to do the 4ork described above 3n <br /> accordance with the rrxl s, zeguxatio 'p Sass �Oac�u3�t County and subject to <br /> i ospeation and approval.' 5%-`"t"c) <br /> Signature of Aaplic t - Titre —t <br /> Datte <br /> M==.ns\"z== (C/o*) <br />