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PLEASE PRINT: APPLICATION FOR ENCROACHMENT PERMIT <br /> Date -�1 , f t.I <br /> OFFICE USE ONLY <br /> To: San Joaquin County <br /> Department of Public Works JOB# l34o5 Z—lB REF# <br /> APN <br /> EXP. DATE CR# <br /> Applicant Name) VALID <br /> r �! TO G t dt DRIVEWAYS: <br /> STREET �Q���✓E <br /> AREATYPE '!3rd5 N QUAD SE <br /> (Mailing Address) ORMS ya <br /> W > I <br /> NOW <br /> TES <br /> 9A �----------- <br /> -- �(; <br /> (City,State,Zip Code) <br /> (Area Code-Telephone Number) <br /> Sketch(Detailed plans may be submitted) <br /> a <br /> The undersigned hereby applies for permission to excavate,construct <br /> the S side of and/or otherwise encroach approximately <br /> County Highway Right-of--Way on <br /> of IP� 3,T{� ,✓� pproximately_ ot/mile <br /> by performing the followin _work escription of o k); <br /> a <br /> Work will commence on or about <br /> ror approximately <br /> 1,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 /> days. <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 <br /> EIPU9 SVWKIAIASTER?SLI'ICROACNME,\7 PERWA?P11GATION DOC r07mgj ate <br />