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APPLICATION FOR ENCROACHMENT PERMIT <br /> PLEASE PRINT: <br /> Date !; �"" j OFFICE USE ONLY <br /> To: San Joaquin County JOB# j 1000S_ REF# <br /> Department of Public Works APN CR# <br /> f/ EXP.DATE <br /> E��C -1C��a_ VALID TO (01S It DRIVEWAYS.- <br /> (Applicant <br /> RIVEWAYS:(Applicant Name) STREET Live -OAV- <br /> AREA QUAD NE ' <br /> I hJ. A -7 TYPE N <br /> (Mailing Address) FORMS JNial, P-2i <br /> NOTES —' <br /> �Z— <br /> (City,State,Zip Code) <br /> (Area Code-Telephone Number) <br /> Sketch(Detailed plans may be submitted) <br /> The undersigned hereby applies for permission to excavate, construct and/or otherwise encroach on County Highway Right-of-Way on <br /> the �x tom—side of m C-/if OA k., tZ b approximately 3c^L)- feet/mile t' A:51 <br /> of JFt r_ i c' t E fz—S , C_'07')I , by performing the following work(description of work): <br /> �T =1tT xi 4..aze- oAk IN - <br /> �c-A 5,1` -r N r— ) <S Lo AT'14 NO I�L'20 <br /> Work will commence on or about � 41 " 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 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 /> n Applicant-Title Date <br /> E WUB&SV.WNIMASTER PS�ENCROACHMENT.PERMFT APPLICATION.DOC 1011087 <br />