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APPLICATION FOR ENCROACRMENT PERMIT <br /> PLEASE PRINT: <br /> Date 2-2 C�% OFFICE USE ONLY <br /> To: San Joaquin County JOB #1��r�1�T REF # -- <br /> Department of Public; Works APN CR' # <br /> � <br /> � EXP. DATE " <br /> a" e lQ ) co , VALID TO 3 /,5 DRIVEWAYS: <br /> (Applicant Name) STREET /2Qi t'PL> lils:" r� <br /> Q AREA QUAD <br /> TYPE <br /> (Mailing Address) FORMS <br /> NOTE <br /> (City, State, Zip Code) <br /> Zo9. R y <br /> (Area Code - Telephone Number) <br /> sketch (Detailed plans may be submitted) <br /> iJ <br /> Z-4J— <br /> sAW 2 <br /> ¢ N, <br /> aeQ 5 <br /> The undersigned hereby applies for permission to excavate, construct and/or <br /> otherwise encro ch on County Highway Right-of-Way on the �o L side of <br /> TV kP�o approximately ?O feet/mile <br /> of G;(2t.*-.4 r S by performing the <br /> following work (description of work) : <br /> S2W¢rte ✓Y, � 1 N .., - , <br /> Work will commence on or about Z-Z(I-O cg for approximately <br /> D- days . <br /> I, 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 an royal.. <br /> Signature of Applicant - Tit e Date <br /> MAST'ER.2S`,PE3S^FD:, (6/OOi <br />