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APPLICATION FOR ENCROACHMENT PERMIT <br /> PLEASE PRINT: <br /> Date %P OFFICE USE ONLY <br /> i <br /> To: San Joaquin County JOB# "13 _3 REF# <br /> Department of Public Works APN CR# <br /> .r, EXP.DATE t o <br /> Jk(C-,z VALID a TO t }m DRIVEWAYS. <br /> Applica t Name STREET Nc,4 CAMp R A. <br /> AREA fgttW eAMf QUAD <br /> TYPE SEA &LEt} ZORES ' <br /> (Maili gAddress) FORMS 5sjww,�-ZIg <br /> NOTES � <br /> (City,State,Zip Code) <br /> (Area Code-Telephone Number) <br /> Sketch(Detailed plans may be submitted) <br /> i <br /> The undersigned hereby applies for permission to ex vate,construct and/or otherwise encroach on County Highway Right-of-Way on <br /> the _ <br /> side of ��Eit/eN'�,�,,,Sapproximately 2 5� fee mile�� <br /> of ,by performing the following work(description of work): <br /> ylls �T¢ , G:.l t� QS c.rn<s�i.�n cL �r 2kcti ��.T,o lel'. <br /> Work will commence on or about— — — / for approximately 2 days. <br /> I,the undersigned,certify that I am the owner of the respective property,or am qualified to represent the owner and agree to do the <br /> work described above in accordance with the rules and regulations of San Joaquin County and subject to inspection and approval. <br /> ( j <br /> ign re of Appli -Title Elate <br /> =_VPI$$VMWMASTERP96NCROACWE.YT PERM?WPOCATON DOC (31WB <br />