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P-5 1!bo Sa(o <br /> APPLICATION FOR ENCROACHMENT PERMIT <br /> PLEASE PRINT: <br /> Date ( '/�{ ct OFFICE USE ONLY <br /> To: San Joaquin County JOB# �? j ��� REF# <br /> Department of Public Works APN CR# <br /> EXP.DATE <br /> C_ VALID DRIVEWAYS: <br /> (Ap licant Name) STREET <br /> AREA ,C�EpOQDQUAD 1Wt LU-1^�(c"C� �Z� TYPE oGE E�G�9C'E�YJ�,nTT <br /> (Mailing Address) FORMS uJ� <br /> _ NOTES <br /> (City,State,Zip Code) <br /> ywc s-VY9' <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 side of l..\y'y U1&. �i approximately q(� &I/mile <br /> of .►o -z , , by performing the following work(description of work): <br /> vetz ` ter_i-« <br /> Work will commence on or about / !/ for approximately D 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-Title Oate <br /> E:IPU6-SV.WKIMA8TER.PSIENCROACHMENT PERMIT APPLICATION.DDC ;01108) <br />