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APPLICATION poR ENCROACH pNRMI* <br /> PLSA3 <br /> PRIM <br /> Date <br /> OOFFICa Vas ONLY <br /> To: San Joaquin County JOS #�?(3 <br /> Department of Public Works R$F # <br /> APN CR # <br /> rli MM. DATs <br /> VAL= -� <br /> (lpplieawt Naats) �- TO DRIVWAY9s' <br /> ARBA D 0 4CAD N <br /> L * -- <br /> (7saili A nes) I+YPETo <br /> _H <br /> FORS <br /> Q NOTE <br /> (city, seat zip cos.) , <br /> .—4 <br /> (Area c6de Telepbone-number) <br /> Sketch (Detailedlass a <br /> P Y be eulsmitted) <br /> The undersigned hereby applies for permieeiot: to excavate, c ru t and/or <br /> e roach C ty 8ighaay Right-of-may � <br /> Proximately e o <br /> of eot 2e <br /> following wo (de a (tion fWk) perfns�the <br /> Me <br /> Work wil coam+ence on or about <br /> days_ for approximately <br /> I, the undersigned certify ghat I am. the. owner of the respective property,qualified to represent the owner arid agree to do prop y, or am <br /> accordance-with the rules, the work-deacribed above in <br /> .insgulatio�ps of San Joaquin County and subject to <br /> 4= 6 <br /> etand rip val. <br /> 71Dplic - Tit:;le <br /> Da 0 <br />