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MW <br /> - ` ~ .4PPL:(GATTON FOR EN'CROACHTENT PERMIT ' <br /> PLEASE PRLN�T: <br /> -- OFFICE USE ONLY <br /> Date ,/0 -- a..$- °l G JOB N REF# <br /> AFN _- SLZD - iii CRV9 d o 3 o Z-7 <br /> To: San Joaquin County HiahWay Department. EXP. DATE <br /> VALID ,/ TO DRIVEWAYS: <br /> STREET <br /> (Applicant Name) AREA QUAD <br /> TYPES <br /> 717-'), Q�a io�l G FORK -cs/�W; <br /> (Mailing Address) NOTE - - <br /> / ave, <br /> (City, State -Zip Code) <br /> :570 - 4q5'6,- 1900 <br /> 4rea Code-Telephone Number _.. -.-. <br /> Ske+.ch(D-a; ed plMs m-Y be-subnit�, <br /> The unde�sbiped hereby applies for permission to excatiate, construct and/or otherwise encroach on County <br /> u;at,w-ay <br /> Ric-ht-of-Way ght-�f_�Vay on the side of n, P approximately <br /> feet 1 mile of ,by performing t <br /> follow-Ing work: (descn_ption of work):�'3 L�•�J tr/E.�Vl S <br /> Work will commence on or about for approximately ?"O_days. <br /> I the undersisped certify that:I am the owner of the respective property, or am Y.Hed to represent the owner t <br /> agree to do the work described above in:accordance v�zth the rules,regulations of San Joaquin(county and subj <br /> to inspection and approvaL <br /> SIGNATURE OF APPLIC..AINT - TALE DATE <br />