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FROM :CAL I FORN I A I;JATEf2 SERO I CI. FA:; NO. :-10946401951 Aug. 1�1 g. O9 � 12:19P F' 4 <br /> APPLIC,ATTOX FOR IWC1t0ACMMKT PERM T <br /> Date MICH USE ONLY <br /> To: San Joaquin County COB Z122! PSF #--. <br /> Department of Public Works APN CR <br /> A .� oR�1khA�C' .t , 5 .+�V R . DATE «-� 02 <br /> vAI,ID S 4_47 To I o•!s-o+"1 DRnnMXY9 z <br /> (Applicant Names) STPMT <br /> TYPE Ogg" <br /> (MailingAddress) e-� F'oRms -aa `vul, Z9 <br /> %A MOTE <br /> (City, Sbbat�e, .ZipCode) <br /> (Area Code - Telephone Number). <br /> Sketch (Detailed planus maty be gu�mitted) . <br /> . VIA <br /> The urWArsigned hereby,applies for permission to.excavate, construct and/or <br /> otherwise-encroach,On Co tYL Highway Might-of-wa;y..om-the , � aide..-of . . <br /> 5fKN\ ►V►MIEW N LU approximately kI's <br /> of NUMWL. • .,. , <br /> . by Verfoxming the <br /> followi ag work (description of work) : • , <br /> y 1C'E \.�N\&T <br /> Work will commence on or-about _ for ap <br /> bC"5 - <br /> proximatel <br /> days.. <br /> 1, the uadersigned certify that I am the owner of the respective property, or ane <br /> qualified to represent the owner and agree to do the work described above in <br /> accordance with the rule <br /> regulatio 'of San 0oaq,4n County and subject to <br /> inspection, and approval.t�c►-CA_b-1 , ` <br /> Sig=ture of Applicant - Title <br /> Data <br />