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:CHL I FORK IA I,JHTER SERS:!I CE <br /> FAX NO. :2094640195 Jul- 21 22009 10:46ANI R <br /> APPLICAT:Cog FOR ENCROXCM=T VMWT <br /> PLEAS�P,• • <br /> Date <br /> OFFXCE Vsz ONLY <br /> TO: San Oroacgin County JO8 $ - `�"� REP <br /> # <br /> Department of public Worke APN <br /> CR # <br /> P - DATE p <br /> VAL= 7 i6-a7 �'O _ b. I.a9 n <br /> {Applicant Xazg) STREET R=MyS <br /> � Q AM � N_ QMD PIIS <br /> — (Mai. iag AddrQss} TYps Rnr- H-OLG <br /> �-� FORMS _55 Lulu), Z9 <br /> NOTE <br /> tuacyr�Sptatee,, .-Up Goth) <br /> I_M <br /> (Area Code - Telephono Number). <br /> Sketch ()retailed flans may 863amdtted) <br /> Tke undersigned hIML ereby applies for <br /> otherwise•-encroach• peri 8sion to,excavate, construct and/or <br /> oa County•Righway Right-of_Way+-aa•the <br /> _ approximately I f <br /> of �h�rL�. Gl ,�.Z'e WF�T' � • <br /> foll.ow.img work (description of,workrk) , t' I �' ' , by"pe-rfoxmjjjq t:he <br /> WOrk will commence oxo or'about <br /> QY ~1'I for approximaCely <br /> +� - <br /> 3:1 <br /> the unde rSi.gned cert ,f ' <br /> qualified to re res x• tbat x am the Owner' <br /> of• t2xe xespect ve -property,"repres the owr�eer a12d-g p perty," or am <br /> accordance With the rtzle x �E to do the work described above in <br /> pProv'al. ati of San Joaq�x A County and subject to <br /> a nspe=Lon and a ` ` (�Q <br /> Signatuzs of App3.,icant: <br /> aascsrc.?s�tsra�y woos <br /> Data <br />