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APPLICATION FOR ENCROACHMENT PERMIT <br /> PLEASE PRINT: <br /> Date t i OFFICE USE ONLY <br /> To: San Joaquin County JOB <br /> '�3�5Z-n . _ REF# <br /> Department of Public Works t APN CR# i <br /> _ W- EXP.DATE <br /> VALID / T O /5� DRIVEWAYS: I <br /> STREET <br /> 8 River Park Place East AREA S?aG,C-r2fAl QUAD <br /> NE k <br /> TYPE oLE �GAaEtilEwTl� <br /> (Mailing Addr <br /> ess) rORMS <br /> i tr M, A J :S..� NOTES —T-` <br /> (City, State,Zip Code) ` <br /> % (o 0 -S:3s LZ <br /> (Area Code-Telephone Number) - <br /> Sketch(Detailed plans may be submitted) <br /> the <br /> undersigned hereby applies for permission to excavate,construct and/or otherwise encroach on County Hig ay Right-of-Way on <br /> side of__ Argyll" approximately fee mile _ <br /> _ by performing the following work(description of work): <br /> d <br /> Work will commence on or about ' <br /> for approximate y� _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-TitleZlvrt'.__ � Vii= <br /> Date <br /> isal71SV.WI(IN.0.Sr[R.PSIB[f,ROhCH61ENr F'F.E6^T QPPLICATiONDQC (01[081 <br />