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FROM i :CHL I FOPH I A I..,IATER SEPI!I CE FAY NO. :20946401,35 Apr. 08 2009 11:230M P 21 <br /> APPL1CATX0N FOP- ENCROACM=T PERMIT <br /> PLEASE PRINT <br /> Date OpYG'8 USE ONLY <br /> To: San 17oaquin County JOB #-13-00 7} P.EF <br /> Department of Public Works APR CR <br /> . CA��aR�1P� ���• S�.R�1 Bgp. DATE 45 .497 _ <br /> VALID, TO n trvEwA s <br /> 1Ap�plioanti Name) S7?MT 496 <br /> A Q= <br /> TY7PE � <br /> Addreals) Fomes s `— <br /> DL <br /> �r1') NOTE <br /> (city, Srnte, .Zip Code) <br /> (Area Code - Telephone Xumber)• <br /> Sketch (Detailed plans may be subudtted) <br /> The undersigned hereby,appljes for <br /> other*'ae-encroach•oa Count, Permis40n. to.excavate, Cotatxuct and/or <br /> X 5h�+ay Raght-of_Way,.&-the =W <br /> appxoximatel <br /> of �N'i�Sl�1n1C'1ti*j1�1 "� y. <br /> following work • by'perfortc4ng the <br /> +' (description of;work) ; <br /> �~`L1"�'►�. ,3`X•+1+ 'E,1..1.. ""•� <br /> $ g , Q <br /> work Will commence oz or'about <br /> for approximately <br /> I, the uadexsigned cextify. that X am the owner' of,the xespeCtxw'e pxopart ax am <br /> qualified to represent the owner auacl agree to do the work desari$ed above in <br /> aCCOrdSLlf:e with the Yu7.le relati Sid of Sari X708 <br /> iaspectian and approval.�pj..: $;d��. County andscbject to <br /> oi <br /> APPlIca=t - Utle <br /> Date <br /> >wcs�trc.rivarrom� f6/oD7 ... <br />