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"APPLICATION FOR ENCROACHMENT PERMIT <br /> PLEASE PRINT: <br /> Date /�z OFFICE USE ONLY <br /> To: San Joaquin County JOB # REF # <br /> p Department of Public WorksAPN CR' <br /> EXP. DATE <br /> VALID T �fi L7', TO DRIVEWAYS: <br /> (Applicant Name) STREET <br /> AREA QUAD <br /> C>Z), 1 ` Cv c TYPE <br /> (Mailing aAddx-ess) FORMS <br /> NOTE A0,67A%1i Q--, A!--6P2-7' <br /> l(City, State,, Zip Code) <br /> (Area Code - Telephone Number) <br /> Sketch (Detailed plans may be submitted) <br /> �c-4 <br /> The undersigned hereby applies for permission to excavate, construct and/or <br /> otherwise encroach on County Highway Right-of-Way-on-the �a4 side of <br /> f �-✓\ approximately ?aC-O feet/mile <br /> of , by performing the <br /> following ork (description pof work) : 1Gc <br /> Giv�li_l iV'L L� W✓��_ C1 �G. <br /> Work will commence on or about Ltc"VL� ZOLA--, for approximately <br /> 75 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 and approval . <br /> Signature of Applicant t1e Date <br /> KASTER.PS"FEES=r, (5/Cci <br />