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APPLICATION FOR. ENCROACHMENT PERMIT <br /> PLEASE PRINT: <br /> 4 OFFICE USE ONLY <br /> Date _ JOB # 11 REF# <br /> IAPN - - CRV# <br /> To: San Joaquin County Highway Department, EXP. DATE —[ <br /> VALID O `-``t cr DRIVEWAYS: <br /> G �a ",3, -► � �c. STREET���—•-�-�n��.-, -� <br /> (Applicant Name) AREA--�'zat- QUAD ---AA, s <br /> 'I TYPE_ T�.�( I t.- <br /> [ "Id I-4a�-�- ��rE. t.?n 3 FORMS <br /> (Ala' Address) NOTE <br /> 0 A �4�,a2 <br /> (City, SWrZip Code) <br /> (Area Code-Telephone Number) <br /> Sketch (Detailed plans may be submitted) <br /> -�c� rh�l'�! a. �'r E FLA -J <br /> The undersigned hereby applies for permission to excavate, construct and/or otherwise encroach on County <br /> IF1-ighway Richt-of-Way on the b 24 o side of W�4c 1`—T%4 T approximately <br /> feet /mile � of / , by performing the <br /> following work: (description of work': <br /> Work will commence on or about 19" bL -R for approximately 1 days. <br /> I the undersigned 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 mspection and approval, <br /> SiGivA ,^ <br /> TUBE OF APPLI�.AiIN7 - TITLE DATE <br />