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AP JWM` SJR%GR4ACjlE 1T Pt l T <br /> P:t;AaE L INT; <br /> QatP f. OFFtGE USE{3t Y <br /> To San Joaquin County .JOB# REF# <br /> Di?parfmnt of Public Woiics APN CR# <br /> "EXP.DATE it <br /> " VAiD ! l' TO fl DRIVEWAYS: <br /> {/ ,uSal3lett STREET <br /> /f AREA QUAD &S ` <br /> TYPE aF �';- 5 * . <br /> (Mailing Address) FORMS ,.. <br /> NOTES <br /> CO <br /> (C4,ftte,Zip Code) <br /> r <br /> (�►rea=��de-Tei��o tUt�+Y�er�. <br /> ketch{ taiiecl p may be submitted <br /> ode ' ned r y a pes#Qr . ► lox tnict ar�d or c se 4ncroa,-h on County t its R 9trt-cif-Wa on <br /> 1 e Ili a ro not ty? C � Wff& <br /> petQrnttvi �nrttstjji'ofw�b�rrtc): <br /> Witt°comrner Qn cx alxut r fior alpZimately ( days. <br /> t;the undersigned,certify that t am the owner-of#ie res0066Ve,property,or am qualified#c>represent the owners agree to do the <br /> wok desc ve in accordance with tlie.rules andd�egulatior�s of San Joaquin C iunty'anii suti)ec##o inspei;#ion"and approva-A k;(, l. <br /> 1 <br /> of Applicant - Ttfie Date <br /> I'PERWTAPP=TMbOC PI/M <br />