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FR0M _RL FCIh ?r WATER oER,�i__ F :, riU. :k94r40gE� Sep. 17 - <br /> [�1=t 1G=1: 1gHM =' 2 <br /> APPLICATION FOR ENCROACHMENT PMZM3:T <br /> RLA E PRINT- <br /> , <br /> Date oklQ OFFXCE rrSE MY <br /> To: San. Joaquin County Jp? # S�dJt3 RSP # . <br /> Department of public Works APN _ CitUP. DATE. # <br /> a <br /> VALID, 0 <br /> (Applicant <br /> Cgamo) 3TPMT 66e AV <br /> AREAS <br /> Typn <br /> TYPE 2 8E C.s.. /doE.,rs <br /> (Mailing Addross) FORMS 2 w <br /> {CIttyq, State, .Zip Code) <br /> (Area code - Telephone X=ober) <br /> Sketch (Detailed jlaMS :may be sivbmitted) <br /> T^ a undersigned hereby,appiies for permission to.excavate,, const=ct and/or <br /> otherwise-encroach-on •CouatY•Highway Right-ofWayt. a' .the OY I yid <br /> APproximately /01 I la&z - <br /> �` <br /> fold work (descry, do by perforating the <br /> p n Of,work} • _.: <br /> J o <br /> 'W'ork will commence on or'about clays.In CS for approaa acately <br /> . <br /> 1, the undersigned certify, that I am the owner of,the respective property.' yr a'm <br /> q=:Lified to represent the owner and agree to do the work described above in <br /> accordance with the rLaes, r aions'of San ao8,�?i1�T3 Couzaty a22d subject to <br /> inspection and approval, <br /> S_q=ature of Applicant Tit:,le -- <br />