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{ <br /> I <br /> f <br /> I <br /> APPLICATION FOR ENCROACHMENT PERMIT <br /> PLEASE PRINT: <br /> 2 <br /> Date OFFICE USE ONLY <br /> To: San Joaquin County JOB# 730!�,6Z—Z.Zt- <br /> Department of Public Works AAN GR# <br /> ( cEXP.DATE O <br /> C. (V VALID DRIVEWAYS: <br /> (Applicant Name) STREET ccra o <br /> AREA ` QUA€? <br /> 1, Lh :UZSa TYPE <br /> ( Addresi) FORMS <br /> Wcjh►. C c NOTES --- i <br /> (City,State,Zip Gariel) j <br /> 5�6— 25G <br /> 53-761.. <br /> (Area Code-Telephone Number) i <br /> Sketch(Detailed pians may be subi-nitted) <br /> - i <br /> i <br /> i <br /> k <br /> The under s' ned hereby applies for permission to eXcavate,construct and/or otherwise encroach'on County Highway Right•of-Way on <br /> the side of_ Loeser Sac /Z r} approximately �� =tion"bf <br /> � <br /> of t'"'` ur by performing the following tivork{ work <br /> AftI f l t aha fo !'ova ode Cc, ) <br /> - i <br /> Work will commence on or about 7— ZolG C�+r�.�ax 1 for approximately days: <br /> I.,the undersigned,certify that 1 am tl4e owrterof the respective property,or am qualified to represent the owner and agree to do the <br /> P ., <br /> r�ork described above in accordance with ft riles"and regulations of San Joaquin County and su 'ect to ins ecii. on and approval. <br /> Slgnature of Applloant=Tltle 'bate <br /> r s rruw.a�sF�rc�rerr vamcr�,eviur�ax{cavi <br /> i <br /> i <br /> I <br />