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APPLICATION FOR ENCROACHMENT PERMIT <br /> PLEASE PRINT: <br /> Date <br /> To: San Joaquin County OFFICE USE ONLY <br /> Department of Public Works JOB# I <br /> _ �!`'C �` REF# <br /> APN <br /> 0 EXP.DATE CR# <br /> (AP licant Name) VALID <br /> STREET d'� �;� �'� DRIVEWAYS: <br /> AREA QUAD <br /> ' ailin Address)� TYPE , <br /> LU �' <br /> FORMS <br /> NOTES <br /> PtY,State,Zip Code) <br /> (Area Code-Telephone Number) <br /> Sketch(Detailed plans may be submitted); <br /> A is 1 5 6�4 A C-1 S C_1 <br /> C>QUc <br /> The undersigned hereby a t� A< �a <br /> Y pplies for <br /> ofe q Permission to excavate;construct and/or otherwise encroach on County Highway Ri ht-of- <br /> -__side of Llot., <br /> approximately�s o 9 Way on <br /> '- --- �_feettmile <br /> ,� o by Performing the following work(description of work): <br /> 1122: G/p <br /> Work will com ence an or about e s <br /> I,the undersigned,certify that i am the owner of the res for appro mately � <br /> work described above in a pective Property, Q d s. <br /> accordance with the rules and regulations of San Jam qualified to Fe <br /> Present County and subject tooinspection aer and 9d approval.ree to the <br /> Sign re of plicant-Title <br /> ..Sign <br /> roroey Date <br />