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APPLICATION FOR ENCROACMMT PERMIT <br /> EU492 PRINT <br /> Date I q 1 15, �)a OFFICE V88 ONLY <br /> To; San Joaquin County TQZ,,# ���dCl REF # <br /> Department of Public Works APN CK # <br /> EXP. D TS r;-15- <br /> SCOT ' MANSOC:F VALID -L To 5-tom- DRIVIVAra: <br /> (Applicant Rome) STREET <br /> QUAD <br /> 6601 80ua0GU CA14YON RD , K20bb �s OV-\ -�--- <br /> (Mailing Addrare) FORMS WyU <br /> SA N PAMIEN , A 91 S�5 NOTE <br /> (City, state zip code) f <br /> (Area Code - Telephone Number) <br /> Sketch (Detailed plane! may bm submitted) <br /> S A. GN S <br /> The undersigned hereby applies for permisaion to excavate, qpnstr ct and/or <br /> otherwise <br /> V ST a YI� nP U p Coanty Highway imaRight-of-Way on the Bide of <br /> �-�r��� �pproxima ON ee /mila.-- � <br /> b ez ormin he <br /> AWN <br /> n of� work) : , <br /> A FT <br /> RGQu(1eGr-1Ev-rS_ <br /> WOrX will commence on or about I for a <br /> days. opproximately <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 /> Signature of Applicant - 4j-ti, �~ Date <br /> Hus?tR.r9�i!RY9C1Q1L /6lOa1 <br />