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APPLICATION .FORENCROACH pgRMIT <br /> PLEASE `PRINT: <br /> Date OFFI <br /> M USE ONLY <br /> To: San Joaquin County JOB <br /> Department of Public Works REF # <br /> APN CR # <br /> 1 �Cl3�l)►'�C A <br /> EXP. ;AT <br /> VALID- <br /> (ApplicantG <br /> Name) ��TO -9-3�-off DRIVEMLYS: <br /> ^^. STREET .�1AI�u ST <br /> _?� V-\C e IN,4 N AREA QUAD <br /> TYPE <br /> (Mailing Address). FORMS. <br /> N'tO r' NOTE <br /> (City, State,-Zip Code) <br /> Allo <br /> -.2-11Z . <br /> (Area Code Telephone Number) <br /> Sketch (Detailed plans may be submitted) <br /> 0 <br /> Z7 o > . <br /> a; 0 C 030 <br /> . nm <br /> The undersigned hereby applies for C <br /> otherwise~encroach on.-County.HighwayeRightiof-Wa excavate, construct a /o r cM <br /> z4 <br /> 'Cr ��C* gt'�+CTGT Y oa the Wi.dgbf�.-- <br /> T Ca�� �U�Yffr <br /> approximately Cfc�O feet/air 4& (D <br /> following work (description of.-work) : Will 2,« 4 ,�� by .pegf i t* <br /> L.1 E1 Ba�6Vjj ►.1 �i�c. PMi!f 1N.� I�L�a-,lam l lA`S.ri-71M�' '�► �( <br /> Work will commence on or'about <br /> ��t �days. for approximately <br /> I, 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 work described above in <br /> accordance with the rules, regulations 'of San Joaquin County and subject to <br /> inspection and approval <br /> QFa 6c�V`1mec-�,� Inkt,LS, <br /> Signat r of Applicant Til;le Ob <br /> Daae <br /> � <br /> 0) <br /> all( <br /> i <br />