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APPLICATION FOR EXCR0AC9ENT PE T <br /> EASE..PRINT <br /> Dats //0 V: �� , c.`� � �;� -7 OFFICE 'CSX. 0xty <br /> To: Ran Joaquin County LTOB REE <br /> bepartment of Public works APM CR <br /> J1= C/7' / ' VALID. 12-UD-17, To �- t 5 e A DRI' EMLYS: <br /> (APpli06.at ) STREET __Lr-A cacz r <br /> AREA <br /> Ck isvT;'cu <br /> �T. TYPE J LAU <br /> C <br /> (CitF, <br /> State, .Zip Code) <br /> (Area; Code - Talephona Number) <br /> gketch--)(Detailed plazas may be submitted) <br /> CD <br /> The vitdersigAad hereby. applies for permission to:excavate, 'CoUstruat and./or . <br /> otherwise- ezcroach on.•Co=t.y.Highway Right-of-wa <br /> e%,� G-�/�.-� �r, Y••�t3•tihe S007-_,-'Z1 s ids..of •, . <br /> -r--=-•-- r__ approximately °` ri 4J11 <br /> S. / _4- �r 7 k. <br /> feet/ - <br /> following work/ (deeer./ip�ti.on of. work) :r /s � = pbY_ `!?e'rfoxmiAg the <br /> �5 <br /> Work willcommexaae ors, or about7rJ <br /> 3 for approximately <br /> dayp. , <br /> 1, the underbigned certify. thgt I am the owner. of• the regpectiv'e -property, or am <br /> qualified to repreaa7lt the rimer and agree to do the work desciri)aed above in <br /> aacordarace with the rules, regulationg of San soaquij, County and subject to <br /> inspection and appitoval. <br /> 3iguature of Applicant - Title V <br /> Darts <br /> Ma@'rRR,P9�@'B�eCH6s. f5/oo1 <br /> 1 <br />