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APPP,'s`A T ION, F!0 faC i5P N T gE",P Ii <br /> PLEASE P RINIT. <br /> Data � _ � _ - �-� __-_� OFFICE USE ONLY <br /> F <br /> To: Sara Joaquin County � JOB REF Ir <br /> Department of Publir:b}fcrftis CR4 <br /> t EXP DATE <br /> 1141D i?-3.- ►S'TO ( -l ,I S DRIVEWAYS: <br /> (Applicant(dame) STREET <br /> AREA � n QUAD S — <br /> _n 0 PWE <br /> (Mallir=g Address) FORMS <br /> ` 1_29A e, 300 <br /> NOTES..'".Z1 �a�iin�9'ZfP Code) <br /> (,area Cade-Telephenu,I!Vrr3b T) <br /> Sketch(retailed plans may be submitted) <br /> The undersigntrl h«;eby applies for peumIssiontoexcavYe'construct and/or o'herwise encroach on Counhy Highway Right-of-Way on <br /> Che side of <br /> °f— approximately (( s feer,'mite _ <br /> b` erformiri the iollowin lvorlt(description of <br /> l p g 9 •ori(). <br /> Wort(101 commence on or about - 1 -for approximately a <br /> � days. <br /> t,the undersigned,certify that f am the owner of the respective property,or am qualified to represent the owner and agree to do the <br /> work described above in accordance writh the rules and regulations of San Joaquin County and subject to inspection and approval, _ <br /> itJ;�acrgre::;g; riicanc r'r le - —�----= i�--- <br /> ID�:te <br /> 's.cEr^,v.—;mc_.r_.ticurvs:.•.•r,-: nsFn as:��..zcaa n:a�r�-ur:�vw.r�:ic�^.;e-,i� <br />