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API' -CATION FOR LNCR.OACH*NT PERMIT l� <br /> PLEASE I'IZIN1': <br /> OFFICE USE ONLY <br /> Date G r/�. g 5 TOB # 1 � 0 n S' REFff <br /> APN - - CRV# <br /> To: San Joaquin County Highway Department. E.XP. DATE /I— I S-6Js' <br /> VALID TO DRIVE,WAYS: <br /> Sp, ,,c=cr 47'f f/ ePc_ti cel ( .cn s�vcl,< STREET F72:vvcH C41,,P PcP< <br /> (Applicant Name) AREA f$ Gk7z).,1 QUAD SE <br /> TYPE ch/ <br /> FORINTS SV224U <br /> (Mailing Address) NOTE <br /> (City, State Zip Code) <br /> C2o 6�-) 9,0, <br /> (Area Code -Telephone Number) <br /> Sketch (Detailed plars:nay be subrsit'.:c.') <br /> See- Ll-H-c4eJ for Work Ar.eq <br /> y <br /> The undersigned hereby applies for permission to excavate, construct and/or otherwise encroach on County <br /> IN-ighway Right-of-Way on the side of,4,.5s approximately <br /> �Q U feet /mile G✓e::7- of /- 5 , , by performing t <br /> following work: (description of work): /.,S/a�/ S� ,T,s Sc.wr r �� Sy'c•.•, /���-i n <br /> Work will commence on or about 0 c-r 95 for approximately Z days. <br /> I the undersigned certify .hat I am the owner of the respective property, or am qualified to represent the owner a <br /> agree to do the work described above in accvrjauce with the rules, regulations of San Joaquin County and subj, <br /> to inspection and approval. <br /> SIOF PLIC'uNT - TITLE DATE <br />