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APPLICATION FOR ENCROACVEN.T PERMXT � <br /> n"02 PRXZgT• <br /> Tor San acaquin County # aooh REF # <br /> Depart.mezt of Public works AaN c& If, <br /> FXP. DATE /O oS 46' <br /> rz x ()uirokg� z rz c— VAL;;D 07 ,zo /O Z.0 z Z'0 aRZ �CAY9: <br /> (Applioant Nom) STREET 4 � <br /> IAEA VAD ` *� y <br /> t� w �� Z 9 * �� <br /> (Mailing Addroas) FORMS <br /> .rerr C r� SIS to b No�� <br /> (City, State, zip 'Coda) <br /> gtu <br /> (Area Code - mel.ephozia Nlr or) <br /> sketch (Derailed plans may be Hubmitted) <br /> U1j FV.a <br /> The undmre%MQ1 hereby appl.iea for permission to exeaV36te, conptr^+ot and/Or <br /> Ptharw:.se ex=&Lch on County,Highway Right-of-way on the seals of <br /> approximately 7 u /Mile. _CU,yr�41 <br /> of ._ --' sups=...- ..._.� C jq by 'peYformixr. the <br /> following work We®criptican of work) : �,g}•.11�.�� g;1 Inc <br /> Work will dommsnce on or about a0u tar approximately <br /> L.N n r days. <br /> I, the undersigned certify that Y am the owner of the respective property, or am <br /> qualified to represent the owner and agree to do the work describad above in <br /> accord,azlve with the rules, regulations of San aoaquin County and dubject to <br /> i%igpection and approVaal. <br /> shy ArAI,U�� •�"�— <br /> lrgsiautFe of Applicant - Title Date <br /> W T19k'fflA\nX00;IbL 16/001 <br /> .yr2,.rn 96/S'd LS0'0N r1'1r'r- 'DNI`H03iONIAN3 X3cA:P+)C11;Wd02:2 't1Z00Z'6S'10012 <br />