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F kUN :-AL I FORH I A :JATER SERF 1 CE FAX NO, :2094640195, Ju 1. 16 2008 1'-:1 0F,[1 P 2 <br /> APPLICATION FOR ENCROAC=NT PERMIT <br /> pateSWg► MICH USE ONLY <br /> To: San Joaquin County JOS # 7. 77 1F" # <br /> Department of Public Works APN CR # <br /> )=. MTE <br /> VALID. TO DRTMAYS: <br /> -(Applicasit same) STREETwV�l�.� <br /> AREA nTVAT) <br /> TYPE SGL yob <br /> (RoAling Addrosa) FORMS <br /> ZJN NOTE <br /> •� (city,"State, <br /> Zip Code) <br /> RR <br /> (Area Code • Telephone Number) <br /> Sketch (]detailed plans may be sisbmi.tted) <br /> The undersigned hereby,applies for permission to.exaavate, construct axed/or <br /> otherwise­encraach•an ..atghway Right-of-way-oa the \N' bid ' of,... <br /> o£ � 1r1* � approximately 1-MIf e S0\3 kk <br /> following work (des do ' � , hY �ae7rfoxmir�g the <br /> n of:work) : W. <br /> Work will commence an or'about b � ti O$ for approximately <br /> days. ,, , <br /> r, the uad6xsigned eertzfy, that z am the own.ex' af, the respective -property, or am <br /> qualified to represent the owner and' agree to do the work described above In <br /> accordance with the z til s, recriiiations'of Saxe %70aquia County and 974bj ect to <br /> inspection and appxova49-1 c1.-C& <br /> Signature of A,ppliaazt Title 4�~ LL �O$ <br /> Date <br />