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APPLICATION FOR ENCR04CMCMT PERMIT <br /> PLEASPRINT• <br /> Date 11-22—o,6 <br /> OFFIC$ USS ONLY <br /> To: San Joaquin County JOB # X30-4?--- 3 <br /> Department f Public WorksRRF # <br /> APN CR # <br /> X013 S C�/ exp. DATE . -o(-o <br /> pli <br /> VALID t Ja�TO 1-01-c)'7 DRIV�PAYB <br /> carat Name) STREET &Yr <br /> ;� AREA C_ Q llitMao� <br /> 2 3 f'� ��T• alt (,C TYPE QUAD <br /> (Nailing Addreee) FORM Cr <br /> * -- <br /> T7)tl <br /> NOTE <br /> (City, Stats,- Sip Code) <br /> (]lraa Codes - Talaphona Number) <br /> Sketch <br /> 709a- <br /> The <br /> ch (Detailed plana may be submitted) <br /> Tv undersigned hereby applies for permiesion to excavate, construct and/or <br /> otherwise eacroach•on County Highway Right-of-4�ay xc the const r1 <br /> approximatel Z 0x714 <br /> fol <br /> I 6 - aide of <br /> tt� t- 9 �2o�r.4� �' feet/fie iu_Fs7' <br /> following work (description of work `�D <br /> C iH v.<{ !� F x"44) E y P X(5o1111N7I1g the <br /> + crak3��•. <br /> 7R ewe SMP <br /> 70 S,0"Y/+ 1+, t ti e — /=�C T�•rrc�) <br /> �-LIE- r!c r-,'(- <br /> Work <br /> ,twork will commence on or about -_ DSC_ <br /> S- 2c7cJ�' for <br /> �Ye• approximately <br /> I, the undersigned certify that I am the owner of the r' active <br /> qualified to represent the owner and a sP Property, or am <br /> acco]•dance`with the rules gree to do the work-described above in <br /> ragulatiO" of San Joaquin County and subject to <br /> 'inspection and approval. <br /> Signatura�iApv.J:Lc t <br /> - Titia' <br /> Date <br />