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APPLICATION FOR ENCROAMONT PERMIT <br /> PLEASE PRINT: <br /> Date 3 -10-08 OFYXCE USE ONLY <br /> To: San Joaquin County LOB # RBF <br /> Department of Public Works APN CR" # <br /> EXP. ]SATE <br /> Western - Water 'V'ALID '' t J o t '031 <br /> D)RXVEWAYS: <br /> (Applicant Naive) STREET <br /> AREA QUAD 'K N� <br /> 707 Aviation Blvd TYPE <br /> (Railing Address) 1.ORMS -'— <br /> Santa Rosa, CA 95403 NOTE <br /> (City, State, zip •code) <br /> 707-217-3643 <br /> (Area Code - Telephone Number) <br /> Sketch (Detailed plana may be submitted) <br /> See attached detailed plan 4170" + <br /> j .�1G'' `�f.9<�� //✓��T.9C� �sh2 S A- f c91--D t'tl� ?'� -- 2, <br /> The undersigned hereby applies for permission to excavate, construct and/or <br /> otherwise encroach on County Highway Right-of-Way on the east side of <br /> N. Devries Rd . approximately 1000 feet/vd-l-e South j <br /> of re way Rd , by :-per forming the <br /> following work (description of work) s eaninq o the C� t v of r r)r9j � a <br /> sewer line via the m n Olc 1 =atad_o f_;� t='4 <br /> Work will commence on or about 17th sof Ma-rrrh for approximately <br /> 10 weer k i nq _ days. <br /> Y, the undersigned certify that t am the owner of the respective property, or am <br /> qualified to represent the o+Vma d agree to do the work described above in <br /> accordance wit a rul4001- k•e ations of San Joaquin County and subject to <br /> inapectio�r d pprotv�'�L,. -' <br /> i <br /> ignaL�y,r-e o,£ A licagt" - Tipee Date <br /> •tMSTER.p�\ftzaCiIDL '4fi/S(*T `/ <br /> I <br /> L0/T0 39dd SlIWb3d OOPS bLE689b60L 6091 BOOL/OT/60 <br /> ■ <br />