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APPUCATIC)N FOR ENCROACHUM PERMIT <br /> PLEASE PRINT: <br /> Date <br /> OFFICE USE ONLY <br /> To: San Joaquin County JOB# �� REF# <br /> Department of Public Works APN CR# <br /> EXP.DATE <br /> VALID ///1 - 0 rte' DRIVEWAYS: <br /> (Applicant Name) STREET s ' <br /> AREA 157r�-kraaAl QUAD � <br /> r " C', " TYPES Sl !I J <br /> (Mailing Address) FORMS , <br /> NOTES <br /> (City,State,Zip Code) <br /> (Area Code-Telephone Number) <br /> Sketch(Detailed plans may be submitted) <br /> ,�- <br /> •� .�r�y'`G'� �"��'Citi''"tj �' �` .1 _S`l'1 <br /> The undersigned hereby applies for permission to excavate,construct and/or otherwise encroach on County Highw Right-of-Way on <br /> the>o� �;_ side of e r,- 1i�r �L x a e�,�- approximately r <br /> /c�G� mile <br /> ption of work): <br /> Work will commence on or about �,c,-�����.��,�� for xirnately <br /> days. <br /> i,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 late <br /> EWU&SVWKWASTER.PSWKROACHMENTKRMITAPPUCAT!ON.DOC (1,1=) <br />