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.• 1 <br /> PLEASE PRL'vT: APPI,PA <br /> TTON FOR ENCROACHMENT PERMIT <br /> Date — /q 7 OFFICE USE ONLY <br /> JOB # '730 79 3 REF# <br /> To: San Joaquin ` FN - - CRV# <br /> County Highway Department. gyp. DATE--5--15--T7 <br /> S ALM TO DRIVEwAyS: <br /> (Applicant Name) TROT �K��' ion s <br /> AREA C,c n�kq i✓� QUAD N E «-----__ <br /> TYPE_ 13or _ s <br /> (Mailing Address) FORMS <br /> NOTE <br /> 0 7 <br /> (City, State Zip Code) <br /> 20 S y0U- Y?S4 <br /> (Area Code-Telephone Number) <br /> Sketch(Detailed plans may be submitted) <br /> Sc ATr�,�H �Kr <br /> The undersigned hereby applies for permission to excavate, construct and/or otherwise encroach on County <br /> I•Eghway Right-of--Way on the - _ C l(o approximately <br /> feet /A ire EAs-r of -7 y <br /> following work: (description of work): N ''' ,by PerfomiinS the <br /> IDER <br /> NEW To /-"�T /63z C Ake R o. <br /> _ Work will commence on or about <br /> for approximate 3 o - <br /> tY days. <br /> I the undersismed certify that I am the owner of the respective property, or am <br /> agree to do the work described above in accordance with the rules,regulations qualified to represent the owner and <br /> to inspection and app". of San Joaquin County and subject <br /> SIGI' TURE OF APPLICANT <br /> DATE <br />