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FROG°1 :i=AL I FORN I A I:JATER SERI)I CE FAX NO. :209464019_5 Jun. 12 2808 02:156PM P 2 <br /> &PPLICATION FOR EN'CROACEM'E'NT PERMIT <br /> PLEASE P9m_:_ <br /> Date Z't\1V 1�� C7,�y OFFICE USE ONLY <br /> To. Safi Joaquin cottz'a.ty JOB # �, �eIz'f RBF # <br /> Department of Public Works APN <br /> � a? ��� VAx,ID T < TO -," - DRIVEWAYS: <br /> {Applicant Name) STRI:ST <br /> AP 5V11- OUAD <br /> Al <br /> TYPE <br /> (Mai.liag Addr,680) FORMS _ ,Li'. -t r <br /> 1�1Y �•�t_ � NOTE � <br /> (City, state" •Zi.p Code) <br /> (Area Code - Telephone Number), <br /> Sketch (Detailed plans may be submitted) <br /> The undersigned hereby,applies for permission to,exaavate, construct and/or <br /> otherwise- encroach-on county F.lighway Right-of-Wagon•the Q ids.,bfi <br /> rr"'�'E._S NNS 1r" approximately d..� fest mi4e <br /> of , by--per <br /> forming the <br /> following work (description of,work) r <br /> C@11.\ <br /> Work will commence on orabout <br /> days. for approximately <br /> Low <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 rule51 requlatiOrlk,Of San Toaquin County and subject to <br /> inspection and approval <br /> Signatuze of �pli.Gant .. Title <br /> Date <br /> i <br />