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- APPLICATION �R-�CHMEN PERMIT <br /> SAN J0 A QUIP) CO, UN T`l <br /> PLEASE PRINT_ 2006 FEB 23 AX <br /> Date FEB 2 3 2006 0EPT G nA LIC WORKS OFFICE USE ONLY <br /> To: San Joacruin County JOB #_ 73a62REF # <br /> Department of Public Works n-PVCR n <br /> EXP. DATE S (o <br /> (� VALID Q^ T6 DRIVEWAYS: <br /> (Applicant Name) <br /> STREET DIILI pp�$LIN3QT * 'r l*&/ <br /> AREA �_�✓ QUA <br /> 44�?4� W ES�r L_Aae- TYPE LG �fb[ES <br /> (Mailing Address) FORMS —7 <br /> NOTE <br /> (City, State, Zip Code) <br /> 14-2- <br /> (Area Code - Telephone Number) <br /> Sketch (Detailed plans may be submitted) <br /> AteeA (oet,, Ei <br /> �j <br /> The undersigned hereby applies for permission to excavate, construct and/or <br /> otherwise encroach on CoHighway Right-of-Way on the side of <br /> UA4 1nt oximately OAF.ADfeet/mile <br /> of by performing the <br /> following work (des�pti of work): <br /> Qd�P <br /> S C <br /> rm <br /> Work 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 <br /> qualified to represent the owner and agree to do the work described above in <br /> accordance with the rules, regulations of San Joaquin County and subject to <br /> 0S�'9-_at-,=e <br /> on and approval. <br /> DE FEB 2 3 2006 <br /> of pklr ant - Titla Date <br /> RETURN PERMITS TO: <br /> MT T.C,Z.PS`•,FE'ESl".4[;L (n/C101 ' <br /> PG&E <br /> JOB PROCESSING DESK -BLD 1 <br /> 4040 WEST LANE <br /> T .rir rnni <br /> t-& Qr.?n4 <br />