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R1 <br /> l <br /> PLEASE PRINT: APPLICATION FOR ENCROACHMENT PERMIT <br /> Date 4c�1�'f ; � <br /> To: <br /> San Joaquin County OFFICE USE ONLY <br /> Department of Public Works JOB# <br /> APN REF# <br /> EXP. DATE CR# <br /> (Applicant Name) I VALID /V TO <br /> STREET ' DRIVEWAYS: <br /> AREA <br /> �. —.�— �I SToct�.-7-lyhl QUAD x <br /> TYPE ------ <br /> FORMS <br /> (Mailing Address) �'caGE ��E� <br /> C' ('�� ; TOW <br /> 1 NOTES - <br /> ' - <br /> (Cit' ,State,Zip Code) <br /> (Area Code-Telephone Number) <br /> Sketch(Detailed plans may be submitted) <br /> The undersigned hereby applies for cern, -tocavate,construct and/or otherwise encroach the side of V <br /> of -=--_Qe- V approximately oach on County Hig Right-of-Wa <br /> erfor :e l ile� yon <br /> ll� <br /> a� k)Tt„ � _ b performing the following work(description of work): <br /> Work will commence on or about <br /> for approximately <br /> I, the undersigned, certify that I am the owner of the respective property --------- <br /> am qualified to represent the owner and agree to do the <br /> days. <br /> work described above in accordance with the rules and regulations of San Joaquin Countyand <br /> i <br /> subject to inspection and approval. <br /> rgnature of Applicant�Ti �- <br /> � ( CU <br /> E:IPU&SV WKIMASTER.PSIENCROACHMENT PERMIT APPLICATION.DOC (0m) Date ---__ <br />