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APPLICATION FOR ENCROACHMENT PERMIT <br /> PLEASE PRINT. <br /> Date tJ��� t p <br /> OFFICE USE ONLY <br /> To: San Joaquin County JOB# <br /> Department of Public Works 7 -'lP <br /> APN REF# <br /> CR# <br /> V c5 !x' EXP. DATE '77 �/ <br /> —=1— J <br /> (Applicant Name) VALIDSTREET / T // DRIVEWAYS: <br /> ' 'kk-L '-WI - 'S,��j AREA �, yy QUAD 152 <br /> / <br /> (Mailing Address) TYPE �!� "AW-1r, <br /> � <br /> FORMS <br /> "E0 To NOTES <br /> (City, State,Zip Code) <br /> (Area Code-Telephone Number) <br /> Sketch(Detailed plans may be submitted) <br /> P&A �07� <br /> The undersigned hereby applies for permissioexcavate, construct and/or otherwise encroach on County Highway Right-of-Way on <br /> the N <br /> of `Atde of �,� �j� approximately 77.x` emile 1,-/ <br /> f w by performing the following work(description of work): <br /> Work will commence on or about_ <br /> for approximately� ,. �� _days. <br /> I, the undersigned,certify that I am the owner of the respective property,or am qualified to represent the owner and agree <br /> to work described above in accordance with the rules and regulations of San Joaquin County and subject to inspection and appighature of Aroval.e <br /> c r T �p� <br /> 5pplicant-Title ��` �2`' <br /> Date <br /> E'PUB-SV WKWASTER P&ENCROACHMENT PERMIT APPLICATION DOC (07/08) <br />