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ECIP 1 :;_HL 1 F=IRN I H I.)HTEF EER!.i I is-E FH' HO. :209464019F', Ji <br /> a I, CI-17 ?G�0,_ 0;:i i ',F hl p E <br /> APPLICATION FOR ENCR0ACM=T PERMIT <br /> Date _SU�...� � OPPICE USE ONLY <br /> To: San Joaquin County aoB X77 REF # <br /> Department; of Public Works ABN # <br /> CNL1F"(JRI�t A A .R 1C , <br /> EXP. DAITE _ '-��=off. <br /> VALID - -08 To <br /> 1App].icazat; 27ame) STRW /.. /GGo_�v •��- <br /> —..-� T'YI'E aLG- <br /> (�aili�sg Addsoss) �'O.RMS <br /> NOTA <br /> (caty, ' <br /> StAt©. ..Zip Code) <br /> (Area code - TeJeP}=e Number) <br /> Sketch (Detailed plans trAy be emitted) <br /> The undersigned hereby.appajeP for permission to.excavate, construct and/or <br /> otherwise~encroach•on -county..Righway Aight-sof-Way:ant the •���C�t'1: 8ida;.i�f <br /> W t LSO �T. <br /> approximately L ' <br /> of '� " t, �. r --,.' . ,. like �tE,ST <br /> following work (description o ,work) : r r by pexfoacmirig the <br /> f <br /> 1-CAT' �' X'`i' L L � _ • <br /> Work vain commence, on <br /> �© or'about C5-"1` a3 `OFA for approximately <br /> days. . <br /> 1, the undersigned certify, that x am the owner' of. the respective 'property, or am <br /> qualified to represent the owner and agxeE to do the vior3t described above in . <br /> accordance with the xuZej r regulations•of San Jeaquin County and subject to <br /> inspectiau and approval, lt �C` �^ <br /> Signature of Applicant '- Title <br /> Date <br /> ►'AS�'BR.Al�YSYO(5JL (L/DO) .. <br /> t <br /> 1 <br />