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K- t l oo Bo'7 <br /> APPLICATION FOR ENCROACHMENT PERMIT <br /> PLEASE PRINT: <br /> Date Z ,tl OFFICE USE ONLY <br /> To: San Joaquin County JOB# �f3p �f',/8 REF# <br /> Department of Public Works APN CR# <br /> EXP. DATE 0/ 5`// <br /> &�C�l VALID J // TO // S// DRIVEWAYS: <br /> (Applicant Name) STREET <br /> _ AREA Ljn/ GJ41 QUAD iV� <br /> TYPE 6eMeceW <br /> (Mailing Address) FORMS may/ <br /> NOTES <br /> vc�Z �AEla- ( <br /> (City,State,Zip Code) <br /> L -v o <br /> (Area Code-Telephone Number) <br /> Sketch(Detailed plans may be submitted) <br /> /0-1 w0wVni c"t 1-4 L� <br /> 309za4lL <br /> The undersigned hereby applies for permission to excavate,construct and/or otherwise encroach on County High Right-of-Way on <br /> the side of fc���Ct31 �� approximately We Vv <br /> of (t\v> by performing the following work(description of work): <br /> CL�a t®l.t"�Es� SI P-C 4 TMJ P <br /> Work will commence on or about I/i / 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 /> —signature of Applicant-Title Date <br /> E:WUB�SV.WNIMASTER.PSIENCROACHMENT PERMIT APPLICATION DOC (01108) <br />