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s <br /> APPLIP.T IOC( FOR.ENCROACHMEf PE& IIT <br /> PLEASE PRINT: <br /> Date fAOFFICE USE ONLY <br /> JOB REFU <br /> APN - - CRV# <br /> To: San Joaquin County Highway Department. EXP. DATE z <br /> i <br /> VALID TOF147-7,v <br /> — STREET .z esh PA� ' # <br /> (Applicant Name) AREA QUAD l/ # <br /> TYPE <br /> aW FORMS S ru ic./ <br /> Nailing Address) NOTE <br /> nA <br /> (City, Statk Zip Code) <br /> (Area Code-Telephone Number) <br /> Sketch(Defafed plans may be submitted) <br /> i <br /> The undersigned hereby applies for permission to excav te, co ct d/or otherwise encroach on County <br /> N-ighway Right-of-Way on the— side of approximately <br /> feet /mile of ..•eta/ , by performing the <br /> following,,vork: (description of tivork): <br /> Work will commence on or about — 9,' <br /> . 3D mor approximately days. <br /> I the undersigned certify that I ara 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--dapprovIal. \ <br /> SIGVATURE 6P APPLIC - TITLE DA <br />