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APPLICATION FORSA-N JOQCE)VEU <br /> ENCROACffiKENT pERba T O U f N COUNTY <br /> PLEASE pRTNT . <br /> '005 DEC 15 AM 8. 4 O <br /> Date - 11- ( �- C� DEPT. OF PUBLIC <br /> WORKS <br /> To: San Joaquin County OPPICB Q33 6XLY <br /> Department of Public works JOB #__2%22-z <br /> PAC,IFIc13 IL APN # <br /> U-- D BA S.13 EXP. D <br /> vALID <br /> (APPlict aaName) �O <br /> -2360 I 1�161-1 i /» AREA <br /> SSTYB- <br /> �o <br /> (bSail3ng .1►ddress)L TYPE <br /> 9 !oG K <br /> /0"".) FORMS <br /> �A c9 �2?v, NOTE --- <br /> (Ciby, state; ZiP Code) <br /> o �.1 <br /> C2oq� <br /> G <br /> .Lfa Telephone Number) <br /> E Boa <br /> Y. be submlCte <br /> - _ <br /> The undersignedI <br /> hereby AP-plies I <br /> otherwise - .or Permission to <br /> eiicibach'oa Count excavate - <br /> G i� F 2 2 p R 1 U CE Y Highway Right-of-wa construct and/or <br /> of , 1-A(Jl) �( �3 A approximatel ,�' on the Vii S T <br /> followingY 4 VC l <br /> work x�� feet/mile side <br /> of <br /> (descr' 4 /ULH2,Zli <br /> -L IN-1 xPtion of work) : 'Fi CZ iL'F 1 fJ 16 S PLS G f P 1 i +-f jC yrs° in 711 <br /> the <br /> ir3 U 2 C/1 r L rZ <br /> T�71�'(Tl.lt AZ:. <br /> Work will co <br /> _ mmence on .or• about . <br /> days, f - �-O - Q r I <br /> for approximately <br /> It!. the un approximately- <br /> Zlaiifi.ed to 9ned certify that I am the o <br /> accordance withptheeIIt the owner weer of the re I <br /> and agree. to do sPeGtive theproperty, or am <br /> ins ection and a Hiles, regulations of Sari Joaquin CouvOrkndescribed- above in <br /> P PPxoval. <br /> Y and subject to I <br /> Si9nature.o .. S <br /> Of A licant -'� - <br /> T3tla -- rjI S <br /> TSR.PS1pggSQ�L f. �� � I <br />