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APPLICATION FOR-ENCkOACHI> ENT PERMU <br /> PLEASE PRINT: <br /> Date <br /> OFFICE USE ONLY <br /> lo: San Joaquin County FB#Department of Public Works r,(_ (1��..� REF# <br /> ebb' f EXP.DATE CR# <br /> ��. � ,• -,.; : , . ,�,,J � . VALID _ <br /> (App11caWt-Na€he 7-----i-'t-TO -/ -2-jam DRIVEWAYS: <br /> STREET P; <br /> AREA <br /> TYPE QUAD <br /> P a 1 ng Address) FORMS <br /> 'r7�r- /z 7w/"j 9 NOTES <br /> (City,State,Zip Gode) - -- <br /> (Area Code-Tel dumber) <br /> v <br /> o <br /> Sketch(Detailed plans may be submitted) <br /> LAL i Rf.15 <br /> ' �M��-t {�C3 C f� f� 1- <br /> N c� I �ot� Gas r <br /> SEWC--V- iNe Tib -�' f1 L( <br /> �Urt(3 SE�JC 3 Boo E —� <br /> • MR�14'eS�,. 12 I� ' �E . J�T7 fl-Gt-v`E•£} . <br /> The undersigned hereby applies for permission to excavate,construct and/or otherwise encroach o c <br /> the :5007--� side of i� cz P n - <br /> .�.� n County High Right-oi Way on <br /> approximately sd fee ile <br /> Vu e <br /> by performing the following work escription of work): <br /> SSE AT'T'AG 3ED Srt� LAN <br /> 1z M I T Aj it 1%RE H <br /> SAL T2 LETT�� <br /> Work will commence on or about v <br /> — fOr aDDrnximafniv <br /> --.........,.,, � days. <br /> I,the undersigned, cedify that I am the owner of the respective property,or am qualified to represent the owner and a ree <br /> work described above in accordance with the rules and regulaiions of San Joaquin County and <br /> subject to inspection and aPP to Qo the- <br /> val. <br /> VIP/'I <br /> Si ature of Applicant e Title <br /> p Lba AE ,�o/ cAa'� Date <br /> -sV.M10EMRALSERWCESCL&21CAL1PU 2VyryAA ^b a y a 7�� <br /> STSZPS,a,. OACMLe{TPERN,ITAPPLJCAT1O111]O„(0?/i� <br />