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A� L Ci-i •IO FOR I+<i1'CROACHIME,NT PIJ1011T Vv <br /> PLEASJ� J?I2L'V7': <br /> Date—LoL1SL ONLY <br /> JOBit ��a r REF <br /> To: San Joaquin Count IIi� `�1v - CRV# <br /> y �hw:iy Department. E) DATE_ 62 —/—pT <br /> VALID _ S- TO_ /lz-/ -9r DRIB ?tiYA2'S: <br /> Cc t,— <br /> !- <br /> .-, i 5 STRET E -e f 01- : <br /> (Applicant Name AREA c Cho QUAD /_ <br /> TYPE_ <br /> ('N'L-' Ing Address) — FORMS ---- <br /> NOTE <br /> Git3t,—State—Zi <br /> 00, <br /> Sketch(Det tile.p:;ss br Submitted) <br /> ------------- <br /> 3 <br /> S <br /> The undersigned hereby applies for permission to excavate, construct and/or otherwise encroach on County <br /> M9hwaY:Richt-of Way on the uj v -er Bei fl�� !, r�,rPslw <br /> of <br /> following work: (description of work /(/ {�o,, by performing t <br /> r /L <br /> S.ani o ae. '��� <br /> Work .,,U commcncc on or,z bout for a <br /> ppro':imatelYdays. <br /> I the undersigned cert that I am ale owner of the.res, <br /> ectivero � , <br /> p perty, or am quaUed to represent the owner a <br /> agree to do L11e work JescnbeJ about;in zcevr;lwce. wish the.rules, regulations ot'S,w Joaquin County and subj <br /> to impec on and appro��al. <br /> S11 ATURE OF APPLiC.�u�TT - s, JO f /�X— <br /> TITLE P )''`S DATE <br />