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APPLICATION FOR ENCROACHMENT PERMIT <br /> PLEASE PRINT- <br /> Date ' OFFICE USE ONLY <br /> To: San Joaquin County <br /> JOB # JU Ii REF #_ <br /> Department of Public Works APN CR' # <br /> EXP. DATE ' <br /> r VALID TO % 15 a DRIVEWAYS: <br /> (Applicant Nzsme) <br /> STREET <br /> >� AREAQUAD ` * — <br /> �0(., 6 CI&H7 WhZe ie%) TYPE — <br /> (Mailing Address) FORMS 551"'J' <br /> NOTE <br /> Zu c_k To)-) <br /> � r <br /> (City, State, Zip Code) <br /> (Area Code - Telephone Number) _ <br /> Sketch (Detailed plans may be submitted) <br /> SCS <br /> The undersigned hereby applies for permission to excavate, construct and/or <br /> otherwise encroach on County Highway Right-of-Way on the e'�E)i2 r"N side of <br /> dIATfit'L'us felo _ approximately — %�� feet/s+&IFe 6 i93f <br /> of t11 i)l�EU by performing the <br /> following work (descri tion of work) : PIES I S�'C�GG <br /> . <br /> %InoaI7S - ;rkE,v70 '� ' PL c G ��� (�J�iDu�T3� �"T� 1tH <br /> X!s Ti✓1 ly E I/9u l ;r -3 " L.4"c'T(2'c .-4 L ,"v"0 q ,7 <br /> 14j-L. zyt)!'1_ in C'oryugbo' 1/1 � � Qi <br /> Work will commence on or aboutfor approximately <br /> days. <br /> T, the undersigned certify that I am the owner of the respective property, or am <br /> qualified to represent the owner and agree to do the work described above in <br /> accordance with the rules, regulations of San Joaquin County and subject to <br /> inspection and approval. <br /> Sign <br /> at re ' Applicant - Title Date <br /> KASTER.PS\FE2SCrmL <br />