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FROM :CALIFORNIA UnTER SERJ i CE FAX NO. :2094640195 Se . <br /> Sep 11 2008 0 :07AM P 2 <br /> APPLICATION FOR ENCROACMMqT PEP=T <br /> PLEASE PRINT• <br /> Dated 1 ► V , <br /> --�— OFIWXCE USE ONLY <br /> To: San aoaquin County Jo$ # 79X 7 REP # <br /> Department of public Works APN Ci #� <br /> B". DATE _ /Z 15--ye <br /> VAL=. TO &Z=1-4 , DR�'0'mys: <br /> {Applicant 2Namo) STREET QRe04e,�_- * <br /> \55C)'A ARE, �✓QuAn „ � <br /> TYPE <br /> Mailing Addrosa) FORMS <br /> • .�d� . �.� �� <br /> NOTE <br /> (city, State, .xip Code) <br /> —RR 61A -moa <br /> (Anter Cone - xel.epholle Number) <br /> Sketch (betailed plaza may be sii tnitted) <br /> The undersigned hereby appl.•ies for Permission to,excavate, construct and/or <br /> otherwise•Qacroach•p� �CoumbY•Ni grhw'ay Right-of-way-o:xt.the <br /> ofbNffapproximately ,.�. ee /fie _CKATM <br /> following work (description of;work) :f '' , }}y'performirig the <br /> w. <br /> work will cownenceon ox'about <br /> days. for approximate) <br /> 2, the undersigned certify, that I am the <br /> qualified to represent toyer of• the respective property, or amthe awrsez and area to do the'' ,ork described above in . <br /> acc0r43M0e with the rotes, regulations'of San Joaquin inspection and approval, County and subject to <br /> SIgnature of App3icaa <br /> ' � Date ' <br /> Mzm-piU"Uc= tc/oa) <br />