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A41CA T ION FOR ENCROACIWNT PERMIT <br /> PLEASE PIUM <br /> OFFICE USE ONLY <br /> Datekpr� '� �4`�� }�I JOB # REFS# <br /> APN - - CRV#X 37 23 <br /> To: San Joaquin County Highway Department. EXP. DATE_ <br /> VALIDi,.i PiZ z.s TO ,Qyelz 2 �� ( RIVE WAYS: <br /> 5tnCKtQn �- '69 5A i Wl STREET �* <br /> (App cant Na e) AREA 57,-,,)C QUAD _� <br /> TYPEflf��? <br /> ? jo 1 0 FORINTS s 5/a &J <br /> 1a' Address <br /> (h � NOTE i�iYlo /zo.�.d CG os v 2 E Q.E;oeax, <br /> L- <br /> 5 c.N <br /> (City, State Zip Code) <br /> (Area Code -Telephone Number) <br /> Sketch(Detailed plans may be submitte cl) <br /> The undersigned hereby applies for permission to excavate, construct and!or otherwise encroach on County <br /> Highway Right-of-Way on the side of E i r,h.t M i 1 e-, Road approximately <br /> feet /mile of , by performing the <br /> following work: (description of work j:OJ nf,-,; k0� 1,-r) <br /> (0 axn +\' ► . <br /> t it - d o 'a t t a <br /> 1/-Z, niliLE Gus e. 5r-. <br /> Work will commence on drabout RQ6 93 n, For approximately_ days. <br /> I the undersigned certify that I am the owner of the respective property,or am 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 ins tion and approval. <br /> SIGT F LICAI T - =E CV Q.V1 t C OOYCI 1 Y' y DATE <br />