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APPLICATION FO$ SNCROACMEM I'MaT <br /> PLEASE PRINT`. <br /> ' Date �` <br /> aFFICs Uss ONLY <br /> To: San Joaquin County F #--LLCL— <br /> ' Department f llc A7orks APN RRA <br /> CIV � <br /> EXP. DTE <br /> STREET(Apel cant rram�} - <br /> (4- AR.EA <br /> Y <br /> C— <br /> (Mag ese) FORMS — -- <br /> sNOTE <br /> (CSty, Stat6, Zip Cada) - <br /> (Area Code - Telephone Xi=ber) -- <br /> ' sketch (DetaLIed plane may be Submitted) <br /> I <br /> �dr _U <br /> G <br /> ' The undersigned hereby applies for permzseian to excavate, construct and/or <br /> otherw�.Be encroach axi County Highway Right-o€-W <br /> s av C1 1 g t �l�, o ey on the aide afof _ <br /> LA-L22-.'feet/mile <br /> ' fa to g r (d sari tion of wo k) .� by performing the _ <br /> ' Ct IJS� U Lt <br /> R rk wz71 commenc on ox t a Ak <br /> ' <br /> for aper imately <br /> days J <br /> r, 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 wnr]c desczxbed abcvc �n <br /> 1 ctecordance the rules, regulations Of San Joaquin COtmty and aubject to <br /> inepec� a SPP <br /> r / U`fdCoG�S% L <br /> e <br /> Hato <br /> ' foST1CR g�7i89Ct�L (6/00) <br />� 1 <br />