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APPLICATION FOR ENCROACHMENT PERANT <br /> SPRINT' <br /> Date — Jr".– / f <br /> — OFFICE USE ONLY <br /> To: San Joaquin County <br /> Department of Public Works JOB# /lODD REF# <br /> APN CR# <br /> t5 �L2R.Y /(''Oic�1 STS EAP.DATE _ <br /> (Appnc�ant ame) STREET s �.C�o / DRIVEWAYS <br /> �SqoCSA '� sr�� QUAD <br /> IMMM Address) TYPE <br /> FORMS <br /> 7-p NOTES <br /> (city,state,ZP Code) O <br /> (Arm woe- reriepbor� ) <br /> Sketch(Detailed pians may be submitted) <br /> ATI;Qc H E.-b <br /> 3sz$.W <br /> The undersigned hereby applies for P"sslon <br /> to excavate,construct <br /> a0or <br /> 60 --_._,_side of ,[.# ,�y �,, °ase encroach on County Highway Right-0f-Way on <br /> Of w. .e..-r Li.✓c. ,tt1, , ,Sgi4c r approximately 00 fe81/mile ht-Of-Way <br /> 0)" o♦ T po by Performing the following work(description of work): <br /> o �4er <br /> Work will commence on or about <br /> ap�oxim�ely <br /> 1,the u days <br /> undersigned <br /> certify that I am the owner of the respective property,or am quay to <br /> work described above in accordance with the rules and regulations of San represent the owner and agree to do the <br /> Joaquin County and subject to inspection and approval. <br /> -Title <br /> E PNLWM'--PW- -MAPKrATOR DOC pW M Date <br />