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9. 2i; _ 2"AiU 244 2 <br /> v <br /> APPLICATION FOR ENCROACHMENT PERMIT <br /> PLEASE PRINT: <br /> Date 7` j t✓ OFFICE USE ONLY <br /> To: San Joaquin County JOB# "34fi!q- REF# <br /> Department of Public Works APN CR# <br /> EXP.DATE 1! <br /> VALID 2 tS #ry T DRIVEWAYS: <br /> (Applicant Name) STREET " — <br /> 6 n AREA 4f�ntN QUAD A <br /> �7 �� UJ ' c TYPE ,PEP1� ur <br /> (Mailing Address) FORhAS S5 1�l <br /> NOTES $� <br /> `T � ?� C <br /> (City,State,zip Code) <br /> (Area Code-Telephone Number) v <br /> Sketch(Detailed plans may be submitted) <br /> The undersigned hereby applies for permission to excavate,construct and/or otherwise encroach on County Highway Right-of-Way on <br /> the �VQ side of ST approximately t.� feetimlle Q <br /> of Trv�'CT-C-lS by performing the following work(description of work): <br /> Work will commence on or about_ z 10 for approximately days. <br /> 1,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 /> Signature of Applicant-Title Date <br /> E.U".ev.wicWSTEPs,£yr,ROACMW,gf Peh547AKL°.c►rk)N.DDC�oe� <br /> I <br />