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FROM <br /> rqi I FORN I q WPTER SERVICE FPX NC. :20946401?5 Feb, 17 2?C6 _-7�22F'M P 2 <br /> APPLICATXON FOR Wc!RoAcRjma pRMT <br /> -795 <br /> yr SE PRINT_: • <br /> nate_ \ ) 110 Up= Un mmy <br /> To. Ban Joaquin C50=ty am REP <br /> Deparl=u mt: of Public Worka Am CR •� <br /> UP' <br /> v%z,ra TO <br /> c]►ppUca:nt xamaAraA <br /> rvacs- <br /> sx'x�r � <br /> {m+iltzg addreaia) hgpme SVA-AV., le-29 <br /> S`CM_UMN QIII. t?3 <br /> (City, state, sip Code) <br /> %,A w%IX1� <br /> (Iran Code - welephona ytL®b"). <br /> S)mtc$ (pcta4led p1azw may be atdxdtted) <br /> 0 41ri Dx <br /> Qi <br /> Li <br /> • fir' � )m <br /> A Ln <br /> DK — <br /> L <br /> The =defpigrnad baby,Apjplxea for pexmi esiox� to.arccavate ao at apd/or <br /> ofwa.se oh•c m••Cove tty Highway ]tight-of- ,Cm•the f� .y ls�.dC <br /> T'Lv <br /> fcllotv=; (4sc'ript�ars war1r) , , <br /> �M4• <br /> 1, <br /> 'r• <br /> 'Woxktvj.0 tae ors or about fo7r approximately <br /> t�.._..._ may$• '� . , <br /> the UU10taesigned oeztify that 3 am the Owner o#,the regpeati.�v'e•P ty, or an <br /> qwe]ified to repr+ese nt the Croner aad agme to do the dark deaaribed above 3n ' <br /> accordance with t:be xul es, 37egu3ationa'of 'U= Jaaqut3m Co=ty and aub3 cct: to <br /> IMA,peatim and approval.W N• I� 0''6 <br /> ai�t� of .'I►ppliaamit •- T3.t ^'— <br /> Date • <br /> +wtsR.yslmvawom u/os3 . <br />