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APPLICATION FOR ENCROACHMENT PERMR <br />PLEASEPRII <br />DWA <br />To: San Josq n Couq <br />DepaV 'rtor,�Pdwar,a <br />//)� (Applcat NM) <br />3InJ(P (6tt n♦ 4 <br />Ft ro 4P-d(- <br />(CLLy, Stas, Zip Cod6) <br />2o`t Z -4Z- V, 5'S <br />(Am CoM Tolson Num¢fr) <br />5"Yi� f J <br />9r. -r- P...,...;" <br />(Enall Addrm) <br />JOB <br />730052 REFf <br />APN <br />Cif _ <br />EXP. DATE <br />VALIDTO <br />STREET—LTeTR'd. <br />Al <br />oc a oralA➢ <br />TYPE <br />k <br />FORpAS <br />SSANVV <br />NOTES <br />Special Conditions <br />DRVEWAYS: <br />i Sketch (Detailed dans may be submitted) <br />&' �— <br />J <br />The hereby aippres for nn to axe e, corustnict andtor otherwae eoaoach m County High Rittaf-Wry on <br />dI"T/ sde d %_T ec.k r I nim fhe bAowi Qwk@asoiptIcncto i). <br />,"v`J,k Cmc a. ..` <br />u596 c./ Ft <br />Work wil mnmence on or after — - Z for appmwatdy days, <br />I, Cre undenl d, ce" that I am mpective pmpetty, or am q ahrred to represent the owner and agree to do the <br />wok deswbed Iis and regut30aa of San Joaqum County and subject to mpecbon and approval. <br />Us <br />--SipslUnedAgOAM TWO <br />F ij z3 <br />