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:CSL I FCiF'p.J I A WATER '=�ERt.!I i=:E <br /> FAX NO. :2994640195 Ma.y. 13 2009 CIS:l P 2- <br /> Op- <br /> OR, ENCROA PERXIT <br /> PL 1SE P TNT: <br /> Date f-t3-0 - <br /> OFFICM VSL ONX.X <br /> To: San L70aquin County X708 <br /> Department of P blic Works "" RL F # <br /> APN C CR DAA !o •1.oq <br /> tAppliczex�t Normo) . VALn> o TO <br /> STREET <br /> w <br /> d� • .�� TYPE <br /> ( .Ling Ad <br /> drT�ess) mat. <br /> FORMS ----�-- <br /> -` NOTE <br /> (City, state' .zip Code) <br /> (Area Code - Telephone D7umber) <br /> SketcL� (D6tailed plan may be submitted) <br /> See- <br /> The undersigaed hereby aPPlies for <br /> otherwise-encroach• Permissiau to,excavata, con <br /> st CG StldJox <br /> on Couat�Y gighway Right-of-wa axe the <br /> Oft;* <br /> Approximately �'? uida: f,.. . <br /> follo ee /mile _ <br /> waxxg nark (descriPtian of;work) :j `' ' ` I Y'Pexfoxmiag the <br /> Work tvi:L commemcer <br /> on or'about <br /> °�ayg• for approximately <br /> 1, the tmdexsigned certify, <br /> ` ified to represent thtbst x am the oumlIel Of. the respective -pro <br /> part with the owner and agree to do P P& Y. or am <br /> r?-les, re s work descried above in <br /> iaspecta.or and a,P.,o -], 5u?ate ons;of Brix abik uia County and subject to <br /> Sign ature of APpxicant �- 'Ta tle 3-o <br /> �'�•Pi1t�s re/oo) beta -• • <br /> r <br />