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h KLIM :CHL 1 F URN 1 H WH I LR SERVICE F HX N0. :209464019t Jun. 24 2009 01:4(HVI r <br /> APPUCATION FOR EN'CROAMS[ NT PERMIT <br /> .&ASE PPaNT <br /> �-19 9 .5 <br /> Date M myL :� 3 IM9.. OFFIC& USE ONLY <br /> To_ San c7oaquin County JrOS � ��' REF # <br /> Department of Public Forks APN CR' <br /> RMP. 7pA'' / d .. _ <br /> (Applicant Xa=a) STREET <br /> AIM S-rw <br /> (Mailing Addions) � FQRMS <br /> (City, State, .Up Code) <br /> CM I-M� <br /> (Area .Code - Telephone Number)• <br /> Sketch (Detailed �I&ng may be ssiabmi tted) <br /> `MP <br /> The undersigned hereby.applies for Pazndssion to,axcavate, construct and/or <br /> otherwise-E.ncroach•on 'County.Highway Right-of-W.Y"oR,the ,� •'�; s'ide:.of, <br /> Aad.. • approximately -Amb I Ce /.p .le l�fC.1� <br /> of ' �R -., r r by PeYformi%ig the <br /> follov ang 'work (description of;work) : .W <br /> E u 8 <br /> I ZUE- <br /> w + <br /> Work will commence on ox'about for approxisrta"ly <br /> days. . <br /> 1, the u dersigned certify, that I am the ow=Pr of.the xespective property, or am <br /> (Vilified to represent the owner azar agree to do the *aork described above in <br /> accordance wa th the n?]e ), regulations.'of San, %7oaqu n'C6uunty and subject to <br /> inspection and approval. -w-CSO <br /> signat=o of .Applicant - Title Date <br /> ' t <br /> 1 <br />