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-FROM ENVIRONEERING INC FRX NO, 9259399621 29 2000 04 : 42PM P2 <br /> APPLICATION FOR ENCROACHMENT PERMIT <br /> L;;ASp E P— RINT - <br /> Date <br /> oFYscz USE ONLY <br /> FAPN <br /> REE' # <br /> TO : San Joaquin CountY CRVDepartment ofPublic WOrks BX <br /> Bxp . DATE <br /> TODRIVEWAYsGha /•' " Ynl� T <br /> (Applicant Name) / AREA 4 w <br /> f0 5• = / op �a C/ D Sf TYPE <br /> (Mailing Address ) FORMS <br /> NOTE <br /> nC/l �vi � CA 5 zo6 <br /> ( City , state , Zip Code) <br /> 09 <br /> (Area Code - Telephone Number) <br /> sketch (Detailed plans may be submitted) <br /> ea r10 51, <br /> Well <br /> a <br /> Lal 50 � otsl - LG7/1 <br /> a /Class y�oo �f /a° ,-k <br /> /cVc SAF l <br /> 1 <br /> The undersigned hereby applies for permission to excavate , construct and/ or <br /> Fat ' side of <br /> othe <br /> is e encroach on unty Highway Right - o£ -way on the eFGS�� <br /> � a / fJuSSwoor/ AYfr a ,proximately _ — hy performin the <br /> of <br /> following work ( eacription of wo ) a irNP . cif oyer e <br /> // Yi PV QP <br /> di h� R. P i P✓P � <br /> r4 PG SPVo <br /> ✓+'%SPS fGM oa a , n aH /r, <br /> F work will commence on or about <br /> 00 p dor approximately <br /> days . <br /> respective <br /> I , the undersigned certify that Y am the ora of ework described abovein <br /> am <br /> qualified to represent the owner and agree <br /> accordance with the rules , regulations of sari Joaquin County and subject to <br /> inspection and approval . <br /> is <br /> _ J , �� r /fes f <br /> l Date <br /> ' signature of Applicant - Title <br /> ' �r�g-pg\pg8BC9pL 16/IB/Bo7 <br />