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PlEASE P~I!\jl: <br />Date OFFICE USE ONLY <br />To:SanJoaquinCounty <br />.Department of Pu~ic WOIt.:S <br />5 t($)6:r~'C 1:@ttiJ f!it,A q.F~t)Ik}. <br />(iCi[jl,~t@,ililOlCllGl1il). <br />(zd!:CI.)(F1?-q tt 32.. <br />(I\WiliilCl]iJe.'lreUelOllilDiiiJ ~jaJmiliJw) <br />DRIVEWAYS: <br />.,----- <br />REI'1\! <br />CR# <br />JOB1\! <br />APl\! <br />EXP.DATE '1(I:!"{'''' <br />VALID .i?lell""TO ~'S{l1"STREET WAs,I>rJ6"17:'-,)~ <br />AREA STiJd"'fbN QUAD 1>5 <br />TYPE ?"Ie.l2eplo~td ~,kw IlIki..,r ;, <br />FORMS "'{wvJ <br />NOTES' <br />Ai>\.3 1\"1 f SD 6: <br />(~.~t£,~!~~~{~m]} <br />Sketch (Detailed plal1s may be submitted) <br />£e.e."'l:H«elned <br />The undersigned hereby applies for permission to excavate,construct and/or otherwise encroach on Counly Hi9=i9ht-{)f-way on <br />the $side of I-\J ~oS"'-.'''"1To "$"t"approximately I 6 IL e i1e E <br />of A 1\+-et-b f A-V .£-t"<!-Ic-fr,,,,by performing the following work (description of work): <br />e;le <br />Work will commence on or about for approximately I;),0 days. <br />1,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 above in accordance with the rules and regulations of San Joaquin Counly and subject to inspection and approval. <br />;<o~ <br />Signature of Applicant.Title 3-~-~oI6 <br />Date