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PLEAS PRINT; APPLICATION FOR ENCROACHMENT PERMIT <br /> E <br /> Date 3 <br /> To: San Joaquin County OFFICE USE ONLY <br /> Department of Public Works JOB# <br /> APN REF <br /> 2 EXP.DATE CR# <br /> (ApplicantVALID <br /> Name) STo, <br /> BEET DRIVEWAYS. <br /> I AREA <br /> (Mailing Address) TYPE QUAD <br /> FORMS <br /> f 'rte e s ? .a NOTES <br /> (City,State,_Z1 <br /> p Code) <br /> 62 <br /> 2 <br /> - 'TelephoneNumber)(Area—&—e <br /> Sketch(Detailed plans may be submitted) <br /> :A <br /> The undersigned hereby by applies for permission to excavate,construct and/or Of <br /> IL r otherwise encroach On County Highway Right-of-Way Way on <br /> dx <br /> ivlftrxec-t�,,,e Ornile <br /> 4r,114, <br /> by performing the following work(description <br /> rarer; d"t S, V, , ,r) S <br /> Of work): <br /> Work will commence on 7orabo—ut -3 <br /> for approximately <br /> 1,the undersigned,certify that I am the owner of the respective property,or am qualified days. <br /> work described above in accordance with the rules and regulations of ed 10 represent the owner and agree to do the <br /> f' tSan Joaquin County and subject to inspection and approval. <br /> � Pplicant Trtle <br /> ure of�A <br /> E APU&SVWKVM9TER,PS*7 <br /> 4RNC'Q`ZWPERMTA�ILICATI0LX� Uate <br />