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APPLICATION FOR ENCROACHMENT PERIWT <br /> Date <br /> OFFICE USE ONLYTo: San Paquin County <br /> JOB Department of Public Woft APN# 1/b.6 REF# <br /> ! � EXP.DATE CR# <br /> c,.�l P lS �Y — <br /> S'f _ <br /> tAPp nE Name) STREET / _ DRIVEWAYS: <br /> ,G —� . <br /> � <br /> tMa""Address) TYPE <br /> FORMS ,� 2 <br /> NOTES j <br /> tray,stere,zip code) <br /> U�X533- ,6phor <br /> eene�� <br /> Nj - <br /> Ske"(Detailed plans may be submdted) <br /> I <br /> t <br /> The undersigned hereby applies for <br /> PrMftion to excav ,constnkt�dlor others erKxoach on <br /> side of ��TT YS r3u County High Right-of-W on <br /> Of a�. - Y — --�wY�3a0 <br /> by Perfortnk�g the fogouri work feeUmile'L'� f4 <br /> Go ` n9 (desaotion of work). <br /> Work w!commence on or about <br /> I, tundersigned. <br /> > > for-rho.,mately days. <br /> he u <br /> nders+9ned,certify that I am the owner of the res <br /> work described above in accordance with the noes and P��Property,or qualified to+fit the owner and agree to do the <br /> regulations San Joaquin County and subject to inspection and approval. <br /> Sgnaare of A .Title �,w <br /> E� ��A1=TCM0fX pYp{) V� <br />