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APP 6CA V4 FOR E-WR®AC'MENT PERMH <br /> PLEASE PRINT a <br /> Date _ ® 16 OFFICE USE ONLY <br /> To: San Joaquin County JOS# 5'�- REF <br /> Department of Public Works ' APN CP.# <br /> P&1) E H ,2 L-1 1) 417 `r"7 -7 EXP.DATE t <br /> VALID I 0 f DRIVEWAYS: <br /> (Applicant h�9ae) S7REEl /00 <br /> Asp <br /> AREA n/ QUAD <br /> TYPEPfit <br /> (MaHing Andress) FORDS 5 �ce ,��'► <br /> -►'� <br /> NOTES � <br /> (City, ate,�rn — ---- <br /> (Area Cocke-Telephone Number) <br /> Sketch(Detailed plans may be submitted) <br /> The undersigned hereby applies for permission to ex avafe, constru f and/or otherwise encroach on County Highw Right-of-Wa on <br /> 'the � side of_ 0 r I► �r � .�S-,.Z�,� approximately �_ <br /> of_ S />�s r/.�Pf1 i4� ,by performing the following work escription of vorlc): <br /> Worlc will commence on or about � �,��� � �� for approximately <br /> days. <br /> I, the undersigned,certify that I am the owner of the respective property,or am qualified to represent the owner and agree'Lo <br /> do the <br /> work described above in accordance with the rules and regulations of San Joaquin County and subject to inspection and approval. <br /> Do, MA C'e56 ��4'rt <br /> Signature of AppHcant-Title -- <br /> �ate <br /> R1:ICCttiRALS:RUICESICLERICA7_IPU&SV.WOVASTERPRR;CR0ACHK,ENTPERr,UJ APPLICUIM DOC (0°/13) <br />