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APPLICATION FOR ENCROACHWI#,T PEW <br /> PLEASE PRINT: <br /> `" <br /> Date <br /> OFFICE USE ONLY <br /> To: San Joaquin County JOB# '�4�r"� - 1"7 REF# <br /> Department of Public Works APN <br /> CR# <br /> EXP.DATE ' <br /> (Applicant Name) VAUD STREET O / DRIVEWAYS: <br /> AREAxa �r <br /> UAD <br /> TYPE •-,— ''�` Q -� <br /> (Mailing Address) <br /> FORMS <br /> NOTES <br /> (City,State,Zip Code) <br /> (Area Code-Telephone Number) <br /> Sketch(Detailed plans may be submitted) <br /> QR -'L.'�-3 <br /> y <br /> The undersned hereby applies for permission to gxcavate,ponshW and/or otherwise <br /> ofe � side of = , h on County H ►hway Way on <br /> --_ t approximately feet/ <br /> -----, by performing the foflawing work( � ): <br /> Work will commence on or about <br /> for aPproxdmakly , <br /> I,the undersigned,certify that I am the owner of the respective Property, <br /> work described above in accordance with the rules and regulations Sanr or oaq <br /> uin amquaKed to represent theownerand agree to do the <br /> County aml su*dto inspecOon and approval. <br /> Y <br /> Signature of Applicant-Titie (� <br /> E1PUB-SV.WKU-.STERPSIENCROACWENTP-WITAPPLICATioN.000 (i,roa) Otte <br />