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BYERR PAGE 021/07 <br /> APPLICATION FDR ENCROACHMENT PERMIT <br /> PLEASE PRINT: <br /> OFPCE USE ONLY <br /> To Sal joaa-jin County REF <br /> Department of Public Works I APN <br /> EXP.DATE 4 <br /> /// <br /> 10:51,9A/ VALID ITO DR1Vr-W4yS <br /> (Applicant Name)w,//C�15 STREET <br /> IAREA <br /> QUAO <br /> 41, 1 TYPE <br /> (Wailing Address) JORMS <br /> 11 NOTES <br /> (Area ode-Tele hone Number) <br /> 17Sketch(Detailed plans may be submitted) <br /> .......... <br /> ereby applies <br /> ne und,�rsigneq h for cermission to excavate.construct a nc),v otherwise encroach on County Kghway RT144,lay on <br /> tie A1,91 <br /> 4�g side of I approxims!ely <br /> by perl'ormInq the following work(description of work,',. <br /> vdcrk Will corrmence on or about—, for approximately <br /> ---------- days <br /> ;he undersigned,ce-tify that' am the ow e"of 1he"e-spectil'o-,property.C,iirr,qualified to represent!tie owner and agree 10 dc Inc. <br /> worF described above ir.accordance with the rules and regulations of San Joaquin Courty and sub,;ecttc inspection and approval <br /> IV4 /0 <br /> ature,of Applicant-Title ate <br />