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P�, c lON FOR�I�iCRO�,CH?YIGP&ERMIT 9 <br /> PLEASE PRINT: <br /> OFFICE USE ONLY <br /> Date ,3- /%-?,7 JOB # REF# <br /> APN -_ - CRV# <br /> To: San Joaquin County Highway Department. EXP, DATE "/T-7 <br /> VALID 3 7 TO DRIVEWAYS: <br /> /%/,//��i - ` ��ihc o• STItLET eeo�v�zo LAMMS O <br /> (Applicant Name) AREA QUAD <br /> TYPE ,Oro R C= <br /> FORMS e- 2 4 <br /> (Alailing Address) NOTE <br /> (City, State Zip Code) <br /> (Area Code-Telephone Number) <br /> Sketch(Detailed plans may be submitter?) - <br /> `- <br /> i <br /> The undersigned hereby applies for permission to excavate, construct and!or otherwise�encroach i n County <br /> Highway Right-of--Way on the side of� &„A9y 6a�Lrh A & , �r�on�.approximately <br /> feet /mile of , by performing the <br /> following work: (description of work): <br /> Work will commence on or about 3zz-6/9 7 for approximately 2 days. <br /> I the undersigned certify that I am the owner of the respective property, or dm qualified to represent the owner and <br /> agree to do the work described above in accordance With the rules, regulations of San Joaquin County and subject <br /> to inspection and approval. <br /> 3/9-97 <br /> All I A-n=OFA1T1T - TITLE �' DATE <br />