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rRUM :CHLIFURNIH WHT-ER SERVICE hRX NU. :20946401y5 reb. 11J 200b 04:dar111 r b <br /> APPLIbATXON FOR MCROAMOM PMWXT <br /> Detre OFFICE USE alLx <br /> TO: Sari Jcagzzi n County '7Q]a # 3° RRF <br /> ])apartment of Public Works Q`fAPN Cly ' # <br /> TE <br /> 4 V'ALM A� TO }7 rvswAYB: <br /> (Ap$li,Ca nt Ham) SMMTOm <br /> AREA = <br /> �RAk _ AtIE� <br /> 1 c)V •�I.'�AoST <br /> ti�11 t,M Mg -SELL AsiF -(Mailing Udresa) FORKS • �c%,,� - n-Z'I <br /> X15&0� - NOTE <br /> - <br /> (City, State, •zip Code) <br /> 3 __� . .._.__...._. . . <br /> (Area Coda - Tolep$ono Number). <br /> Sketch (Detailed plana may be submitted) <br /> The undersigned hereby.applies for permission to.excavate ns• rut /or CMuv%,k <br /> otherwise-enc ach•on, county, i-ghway Right-of-Way-'on-the.the 1i• <br /> V' approximately ee y <br /> of �' , ' by'Vatfozm izlg the <br /> followin work (description of work <br /> K ., <br /> L <br /> Work Vill commence on or'about: fox approximately <br /> days. ' <br /> I, the undersigned certify that I am the owO,er of the respective property, Or am <br /> qualified to represent the owner and agree to do the u6rk described above in , <br /> accordance with thees, regulati of San Joaquin County and subject to <br /> inspection and appro a� a <br /> si.guatuxe of Applicant - fttle Data — <br /> ,a�.vsMvmse� <br />