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APPLICATION FOR ENCROACI3MENT PERMIT <br /> PLEASE PRINT: <br /> OFFICE 178E ONLY <br /> To: San Joaquin County JOB # 7-7 <br /> Department of Public Works ! �' F:# <br /> APN <br /> EXP. BATE CR' # <br /> o <br /> VAT,ID. TO B DRIVEWAYS: <br /> (Applicant Names) STREET �� �-, <br /> r55o W :VtZ V J'NT 5C. 10o AREA Y QUAD <br /> TYPE -726-'xNjIV <br /> (M ailing 'Addreas) FORMS <br /> so�r��o � ao3 NOTE <br /> (City, State, .Zip mode) <br /> (Area Code - Telephone Number) <br /> Sketch (Detailed plans may be submitted) <br /> O -U <D 3�1 <br /> >��� <br /> c cx� c T <br /> C i ' `..)M. <br /> L,f' <br /> otherwise-encroach on County <br /> The undersigned hereby applies for permission to.exc °�avate, construct an !ori <br /> ]3ighway Right-of-Wa on•the a <br /> be�of �ev� .�o�ly ` <br /> following work (descrition of:.work) : b x'�Y( ing the <br /> ' r u <br /> Vr t <br /> W <br /> Work will commence on OV about <br /> Q days, for approximately <br /> I, the undersigned certify that I am the owner of. the respective -property, or a <br /> qualified to represent the owner and agree to do the work described abovein m <br /> accordance with the rul s, regulat'ons 'of San Joaquin County and subject to <br /> inspection and approval�ffj-'w�� , <br /> Signature ofApplicant Title �� v <br /> Dates <br /> (6/001 <br /> XhSTSR.PS\nUaML <br />