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APPLICATION FOR ENCROACHMENT PERMIT <br /> PLEASE PRINT: <br /> 3— 7—9 OFFICE USE ONLY <br /> Date <br /> JOB # � 30"Z7 3 REF# <br /> APN - - CRV## <br /> To: San Joaquin County Hi <br /> szhway Department. EXP. DATE <br /> -_ c 7 <br /> n j VALID 3-17-97 TO G -/-47 DRIVEWAYS: <br /> STREET LAW--6 s <br /> (Applicant Name) AREA /?-qac ,J QUAD &- <br /> TYPE 17Z�C-/-Jcuf <br /> FORMS <br /> (Mailing Address) NOTE <br /> (City, State Zip Code) <br /> oq <br /> (Area Code-Telephone Number) <br /> Sketch(Detailed plans may be submit+.ed) <br /> r <br /> U <br /> 2_--1 Z a 0-6 . 6 v I <br /> The undersigned hereby applies for permission to excavate, construct and!or otherwise encroach on County <br /> I��way Right-of-Wayon the W-) T r r <br /> side of 1�•��t� �..; �:-. iv� approximately <br /> feet /mile of , by performing the <br /> following work: (description of work j: '>v�,• <_ Y <br /> r, <br /> Work will commence on or about for approximately days. <br /> I the undersiped certify that I am the owner of the respective property, or am qualified to represent the owner and <br /> agree to do the work described above in accordance with the rules, regulations of San Joaquin County and subject <br /> to inspection and approval. <br /> SIGNATURE OF APPLICANT - TTI'LE DATE <br />