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APPLICATION FOR ENCROACHMENT PERMIT <br /> Date W - /—/-- <br /> _ <br /> ----- OFFICE USE ONLY <br /> To: San Joaquin County 1 <br /> PN <br /> Department of Public Works A # �� — REF# <br /> EXP.DPN <br /> ATE <br /> CR# <br /> cant NUD DRIVEWAYS: <br /> VA ,Z� ii // ----- --- <br /> ) -'�-'=�• STREET B•�i9 // <br /> � �f"A t> AREA <br /> �r QUAD Gc . <br /> (M�Img Address) ��' �•�r <br /> MSES --- i <br /> (City.State,ZiP Code) <br /> - 6 1 R, <br /> (af rea Code-Telephone Nom) ----i <br /> Sketch(Detailed plans maybe submitted) <br /> I <br /> The undersigned hereby dies for ----- <br /> Of Mi ST 9A Ae,_._side of RALpSr� construct andlo happroximately .&10 . County Highway Right-of Way on <br /> f ------,., �T01►i by perfortnmg 1 feet/mile A <br /> 0 c-4 3 falawing wok(description of work): <br /> A,S7 d- -- To <br /> Work will commence on or about <br /> for a�roximately <br /> 1,the undersigned,certify that I am the owner of the res days, <br /> work described move in acx;ordance with the rules ander Property,or am qualified to represent the owner and agree to do the <br /> regulations of San.loaquin County and subject to inspection and approval. <br /> e of Apert-Title, ' <br /> E'�'" °�„�►���.� Date <br />