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FROM :CALIFORNIA I,,IATEF' SERI;I C.E FAX NO. :2094640195 Au q. 14 200, 12:U4t T9 H <br /> AppriThTnu FOR IW(MOACMMT PMMTT <br /> • EA E PRINT: [��p Q ' <br /> Date w � pPM8 USE ONLY To: San Joaquin County JOB <br /> ]Department of POlic Works lAPN C1 <br /> DATE �s <br /> — -- V I,Ti> o ♦ 0 '0 DRMMYS z <br /> (Applioatat Some) 8M=T' L4rd A, � <br /> Wailing Addxeaa) FORMS <br /> (city, sta,te' .Zip Co") <br /> (Area Codes - Telephone Mt tuber) <br /> Sketch (Detailed.plans racy be Bubmitted) , <br /> The Lmdersigned hereby,applies for permission to.excavate, qowtCt and/or <br /> otherwine-encroach-on, County R ghway Right-of-wgyon fixe W �.• siel�' _ <br /> approximately ese /m3,Ies <br /> of by performing the <br /> fo],7, wi work ( p4on of wo k) - .: <br /> Work will commence on'ox'about for approximately <br /> O <br /> days,. <br /> I, Waa undersigned certify that x am the owaaz< of the respective property, or am <br /> qualified to represent the Omer and .agree to do the *,cork descried above in <br /> accordance with the rules,47,aR7 <br /> itions'of San. Joagiu3z County and s'axbj ect to <br /> inspection and approval. <br /> Sigitkt=a of Applicant - Title - ' <br /> Data <br /> w�srast.aslvz tc/oor . <br />