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Al PLS&1 iON FOR ENCROACH: I*PERMIT <br /> PLEASE PItIN'1': <br /> OFFICE USE ONLY <br /> Date ' JOB # /10 C)�7 REF4 <br /> APN 1 j - Z30 - Z-- CRV# 0 0 3 7¢S" <br /> To: San Joaquin County Highway Department. Ems'. DATE_ly <br /> rr VtA�LID a TO DRIVEWAYS: <br /> ( f'' 1 lek 7%� STREET iv .�v� <br /> (Applicant Name) AREA sioc ro QUAD GS <br /> TYPE TX56V� # <br /> FORMS <br /> (Mailing'Addre�) NOTE <br /> 6671fob /-eye ELL-, <br /> (City, State Zip Code) <br /> t./ :r <br /> (Area-Code -Telephone Number) <br /> Sketch(Detaile3 plans tray be submitted) <br /> 7a <br /> T — <br /> _ s <br /> 0 <br /> The undersigned hereby applies for permission to excavate,construct and/or otherwise encroach on County <br /> I�-ighway Ria - f-Way on the sT side of � �ze`/ approximately <br /> D 0 y feet r mile �eCr rl� of d s�iN��•'Y sr` _ by Performing the <br /> following livor-: (description of work j: <br /> Work will commence on or about 3 iD -7 for approximately days. <br /> I the undersigzred certify that I am the owner of the respective property,or am qualified to represent the owner and <br /> -: <br /> agree to do the work described above in accord.1nce with the rules,regulations of b:ui Joaquin County and subject <br /> to inspection and approval. <br /> SIGNATURE OF APPLICANT - TITLE DATE <br />