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PLEAS€ PRINT, <br />Date L7'.mlo <br />To: San Joaquin Gounty <br />Department of Public Works <br />CA t_l r• ne A) i fl \dfl i i tZ c�7L f�lS l Cr C <br />• {Appttr:antfVa�ne) <br />• (Matitng ddress) <br />(City, States Zip Code) <br />%091 1 <br />(Area Code a Telephone Number) <br />M96 <br />OFFICE USE ONLY <br />APPLICATION <br />FOR ENCROAGNMENT PERMIT I I I . <br />PLEAS€ PRINT, <br />Date L7'.mlo <br />To: San Joaquin Gounty <br />Department of Public Works <br />CA t_l r• ne A) i fl \dfl i i tZ c�7L f�lS l Cr C <br />• {Appttr:antfVa�ne) <br />• (Matitng ddress) <br />(City, States Zip Code) <br />%091 1 <br />(Area Code a Telephone Number) <br />M96 <br />Sketch {Detailedplansmm, besh6miffed) , <br />The undersignedhereby appliesfor pentiissigntopxcavate,cgnsiructaitdCgrotheJwtseencroaohonCountyHigh• RighGoiWayon <br />fxq 202.0 <br />Date <br />theOth sideof Tomcl�o a1: nc apprgximately; fee mile <br />°f AL1( by perfonnfigthefollowfngwork( escnptionof.work}: <br />[,the undersigned, certify that l ant the owner ofthe respective property, or am qual(hed to representthe ewner and agree fo do <br />warkdescdbedahoveinaccoMancawlfhfhemiesandregufationsnfSan Joaquin Gountyandsubjectt°inspecgonandapproval. • <br />HP� is 1-x'1 , <br />SignafureofAppllca� dT14te <br />t1CF1l�IW&EkNCESIgFfdCpLuil&54.V.TNMSIEYPSl^H(gOAEµUflRPFft4Y7Ar%bA71M(000 �ogl3J E <br />OFFICE USE ONLY <br />JOB# <br />rMx77 REF <br />APN <br />_ eR# <br />EXP. DATE <br />S A ¢o <br />VALID <br />2 IO 20 To •S/ Zo DRIVEWAY&' <br />STREET <br />TarwNllgwk 9L. ' ° <br />AREA <br />sL eek%rj QUAD _ ms k J <br />TYPE <br />wsa moia 6e,* bArb✓N+✓� <br />FORMS <br />S�t✓p/, Pi2_7,' 4e Ow <br />NOTES <br />SfKc�w l G+o tJY9m oaS' <br />Sketch {Detailedplansmm, besh6miffed) , <br />The undersignedhereby appliesfor pentiissigntopxcavate,cgnsiructaitdCgrotheJwtseencroaohonCountyHigh• RighGoiWayon <br />fxq 202.0 <br />Date <br />theOth sideof Tomcl�o a1: nc apprgximately; fee mile <br />°f AL1( by perfonnfigthefollowfngwork( escnptionof.work}: <br />[,the undersigned, certify that l ant the owner ofthe respective property, or am qual(hed to representthe ewner and agree fo do <br />warkdescdbedahoveinaccoMancawlfhfhemiesandregufationsnfSan Joaquin Gountyandsubjectt°inspecgonandapproval. • <br />HP� is 1-x'1 , <br />SignafureofAppllca� dT14te <br />t1CF1l�IW&EkNCESIgFfdCpLuil&54.V.TNMSIEYPSl^H(gOAEµUflRPFft4Y7Ar%bA71M(000 �ogl3J E <br />