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APF CATI N FQR f:lwK GHME.M rtma17 <br />�I:E�S�.PRIN7'• <br />Date A�c <br />TV San Joaquin County <br />Deorlment ofPubAc- Works <br />Skeipll.�l�e�ail�l plans may be s�ibi�ltted) <br />The u tiers' ed Nr�by applies for perrr�ssior� ta;exeavate, c;onstr�ctendlor gthet►��se encroaEh on Countyft <br />oFflut USE ONLY <br />jos# R <br />ASN cR# <br />EXP. BATE <br />VALID TO DRIVEWAYS. <br />5TRM <br />AREA 4UA0 <br />TYPE <br />PODS <br />(NOTES <br />.l�figh Right of� <br />.the side ofi..1c1-�...1�• _ approximately j.� � fe lfe <br />by oerformina the following wor1� e. nptian of <br />oamr»ence an or <br />I, the ur�der�►gned, cem <br />'jr fihat.i am the o�unar � #ie respealiue prgp�erty,. or �m qualified to representthe owner�and agree to do�h� <br />work described eibove, in aocardancwith the rula� and requlat�nns of fan �1aaq�in County aril subjeal, to irisgectlnri acid approval: <br />Ll <br />Y:�f 15 6.7�L�3`.�I,CLAN?11i7iYPF�A1ti"i±F21C�71CYi�ac (ORiRtl} <br />13at� <br />