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04/28/2008 13:12 2094689324 SJCO PERMITS PAGE 02/03 <br /> APPLZCATION FOR ENCROACHMENT PERMIT <br /> MRAp- PRINT <br /> Date / " 9-0 OFFICE V8& On y <br /> To: San Joaquin County JOB #_/��� REF # <br /> Department of: Public works APN CR # <br /> LY <br /> rr Exp. DAT p <br /> &'e 6 Atu C,r- f'"�7/n q .SDC)Y_rt/ VALID" o T O DRZVEWAT9_ <br /> - (Applicant Nahte) STREET w <br /> AREQUAD <br /> f Q C]��X Ln_•1•� <br /> TYPEr � <br /> (Mail <br /> ing Address) FO&MS <br /> 1!_11)Rf1 :CCN . .C�A �SC�S�(y NOTE <br /> (City, State, Zig Code) <br /> (Area Code - Telephone Number) <br /> Sketch. (Detailed plane inay be submitted) . <br /> The undersigned hereby app7_ies for permission to.,excavate, .c st"ruct .and/or <br /> otherwise'-encros h on County Highway Right-of-fty oa.the e,'dS_,oP <br /> approximately --a-rlvi=�" feet:� }� fVF <br /> -ef __R,"A NEw iV^o2E , I I " . • kry erfo g the <br /> following work (de- cription of work) : <br /> work will commence on or about for apprdximately <br /> days, <br /> 1, 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 - Title Date <br /> MRP2TR.PBl19iaQInG tS/001 , <br /> t <br /> Z 'd 9601-SBL-60z e.Anel JBO :L0 80 i0 ReW <br />