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APPUCATIOR'FOR ENCROACHMENT N'i• tT <br /> PLEASE PRINT: <br /> Date 3 _- <br /> OFFtCE USE ONLY <br /> To: San Joaquin County JOB# , '' REF# <br /> Department of Public Works APN CR# <br /> EXP.DATE <br /> GC.%mss� L L.C <br /> vALlo • To l=r ► Ers: <br /> 9� <br /> (Applicant Name) STREET <br /> AREA €UAD <br /> TYPE <br /> (Mailing Address) FORMS <br /> •�UiStran �: <br /> cf1 4Ws-&s NOTES <br /> (Cit , State,Zip Code) <br /> (707) '77y-IS-18 <br /> (Area Code-Telephone Number) <br /> Sketch(Detailed plans may be submitted) 1 <br /> r9i(ETtTr �n <br /> ! w w~rP <br /> The undersigned hereby applies for permission to excavate,construct and/or otherwise Ij�; 11 <br /> the sidasof 2tr14 , tat er` " o <br /> of9�Y�„s1.,,4+.� �ziY ,by pefollow <br /> the WkAft <br /> d� n <br /> Work will commence on or about 8•v8 -a <br /> 20 a for app= Lely days.; <br /> I,the unders' ed,certify th I am the owner of the re cdve property, <br /> work de , d above in ordance with the rules and regulations of San J a • Com quaffW unty,Joaquin rrty s to <br /> Signature of Applicant-Title ✓ <br /> Y.%FORMS d TEMPLATEMNCROACHMENT PERMIT APPUCATION,doc WM) Date <br />