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APPLICATION FOR ENCROACMINT PEMd=T <br /> PLEASE PRINT: <br /> Date -1 rCi 11,9016 OFFICE USE ONLY <br /> To: San Joaquin County JOB # REP # <br /> Department of Public Works APN CR' # <br /> M. DATE <br /> -� a 'E$Mat 0S . VALID. (1 1>Of TO q-/_T--6W DRIVMMYS <br /> (Applicant Name) STREET Sotro Ave <br /> ;� AREAS 0C i \ pQUAD epi a <br /> ( € A t" k'J' c �, 2'�i TYPE; 1! <br /> t'a T C n <br /> (Nailing Address) PORMS- <br /> �. `�... NOTE <br /> CA <br /> (City, State, Zip Code) <br /> (Asea Code - Telephone Mmber). <br /> Sketch (Detailed plans may be submitted) <br /> The undersigned hereby applies for permission to.excavate, construct and/or ._ <br /> otherwise erLcroach on County. Highway Right-of-Way.-on the <br /> approximately z /mile <br /> of G.`� .Li1 a � . :. . by pear€orming the <br /> following work (description of.work) : - L ,ictt o") <br /> Work will commence on or about3='t". i Ot�1 for 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 /> ure 3iS - Title Date <br /> '\FMCHDL (6/00) <br />