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I <br /> I <br /> i <br /> i I <br /> APPLICATION FOR ENCROACHMENT PERMIT <br /> I <br /> PLEASE PRINT: <br /> Date <br /> OFFICE USE pNLY <br /> i <br /> To: San Joaquin County JpB# /r ? _ REF#Department of Public Works J08 <br /> GR# <br /> -, EXP.DATE l <br /> i �.Jh 14C`.., VALID TO <br /> DRIVEWAYS' <br /> I• <br /> (A pp rcar>t-Name) STREET <br /> AREA -�_ QUAD <br /> (Mailing Address) TYPE <br /> FORMS <br /> NOTE$ <br /> {City,State;Zip Code) <br /> (Area Code-Telephone Number) <br /> Sketch(Detailed plans may be submitted) <br /> Ae <br /> The undersigned hereby applies for permission to excavate,Construct and/or otherwise encroach on Count Highway <br /> the--G-- side of - Y 9 y on <br /> of �� , approximately <br /> by performing the following work(description of work): <br /> I <br /> i <br /> Work will commence on or about <br /> for approximately I <br /> —�.�-.... days. <br /> 1,the undersigned,certify that I am the owner of the respective property,or am qualified o.represent the owner and agree to do the <br /> work described above in accordance with the rules and regulations of San—Jo Ced and subject e <br /> �— q4 tY 1 inspection an ;appro* <br /> A <br /> c <br /> r nature <br /> � o�Applic�ant­--Tifile <br /> Date' <br /> E.9PUBLV.W6iA rtNPfiTWA=KMFNT PERM APPUCAYMKDDD 191M <br /> 1 7 <br /> TT/90 39dd H0310NIAN3 X3dV LLTOTS8916 Lir:ET 0TOZ/0T/TT <br />