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r <br /> APPLICATION FOR EMCROACYUMENF91 PERMIT <br /> PLEASE PRINT: <br /> Date _RAs OFFICE USE ONLY <br /> To: San Joaquin County JOB 97 _ REF# <br /> Department of Public Works APN CR# <br /> EXP.DATE <br /> �—I VALID y-/ - TO I I—15 -1 S DRIVEWAYS: <br /> (Applicant flame) STREET oc Yuki C-t t <br /> � <br /> ,.. AREA �Lc.ko QUAD L5 6�� �P - adv TYPE <br /> (Mailing Address) FORMS S <br /> q S2 oq NOTES <br /> (City,State,Zip Code) <br /> 6— 17 G7 <br /> (Area Code-Telephone Number) <br /> Sketch (Detailed plans may be submitted) <br /> 3115 -5437 <br /> The updersigned hereby appliekfor permission to e,2ccav te,construct and/or otherwise enc r on County Highway Right-of-Way on <br /> the Jea side of JPci approximately _ysumile S <br /> of , v. ,by perfo ing the following work(description of work): <br /> ✓ 4v i WA I <br /> Work will commence on or about for approximately CIO 6days. <br /> I,the undersigned,certify that I am the owner of the respective property,or am qualified to represent the owner and agree to do the <br /> work described a n accordance with the rules and regulations of San Joaquin County and subject to inspection and approval. <br /> pe- I- I/I I/I -Ir <br /> a e of Applicant-Title Date <br /> L7:10ENTRALSEROICESICLERICALIFUMVVVdKRAASTER.PSIEf4CROACHI✓,,ENTPERPdITAPPLICATION.000(0?113) <br />