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JHN- 'L -3008(M0W 09: 33 t4DOESTO CONTRRCT ADMIN <br /> (FAx18095244801 P n02:''OD3 <br /> APPLICATION FOR ENCROACHMENT PERMIT <br /> PLEASE PRINT: <br /> Date <br /> OFFICE F9E ONLY <br /> To: San Joaquin County JO <br /> Department of Public works REF # <br /> APN CR. # <br /> y¢-r� J` E'XP. DATE .. J'/ <br /> VALIDeZ� TO <br /> (App_1icant Name) STREET L_ �T DR7VRWAXS; <br /> a 310 Z ���D//T m AREA T r QUAD <br /> TYPE G � <br /> (Mailing Address) FORMS � — <br /> Z <br /> 4 q�"a 1 D NOTE <br /> (City, State, Zip Code) <br /> (Area Code - Telephone N=ber) <br /> Sketch U7etailed plans may be submitted) <br /> ` The undersigned hereby applies for permission to excavate,- construct `and/or <br /> otherwise encro ch on County Highway--Right-of-•Way on the +y . . <br /> l0/(v(a� -side -of <br /> of f.�it1� rr- p� imately / ee mile LLJ <br /> following work (description of work) ; 17 rC �� y p rfo� he <br /> OF Ad <br /> Work will commence on or. about _ <br /> -�--�.---.-___ days. for approximately <br /> 1, the undersigned certify that I am the owner of the respective property, br am <br /> cqualified to represent. the owner and agree to do the work described above in <br /> accord -nce with the rules, regulations of San L7oaquax� County and subject to <br /> inspection and approval. y� <br /> r <br /> gnat r of Applicant <br /> //0� Date ---— <br /> NJiB�-yF YASC7R+G �-ry kvnn) <br />