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APPLICATION FOR ENCROACHMENT PERMIT <br /> PLE&�p i <br /> Date .7 - a 6- r <br /> OFFICE USE ONLY <br /> To: San,Joaquin County JOB# <br /> Department of Public Works APN REF# <br /> CR# <br /> lV1P.J -t<'��r�� Z�,,J'(.�Sf VAUD <br /> EXP.DATE '9 S _ <br /> No <br /> (AppirCant ) STREET T /S DRIVEWAYS: <br /> BU G. <br /> GA 4- 7 AREA TYPE -��tMQUAD <br /> FORMS Z4 <br /> —A q 3;0?D 6 NOTES <br /> (cny,State,Zip Code) <br /> Sketch(Detailed plans maybe submitted) <br /> A <br /> The undersigned hereby appkes for Permission to excavate,construct <br /> the&20,V ____side of CC,4PC�,SZ�,Q� -�G and/orotherwise encroach County Highway Rlgtrt-of•Way on <br /> A L1 T'L�GE [,��. ,�iDC,L.Tdtiapproximately_L�O <br /> by Perfonnxng the <br /> following <br /> work( pbon of work): <br /> (Z�S �. <br /> 0 <br /> Work will commence on or about <br /> ` for aPRroximajely n days. <br /> I,the undersigned,certify that I am the owner of the respectiveProperty, <br /> Work described above in accord&xe with the noes and reguiations o Joaquin County aor am qualifed to�subjethe ct inspectiono er agree to do the <br /> and approval, <br /> r� <br /> *�—Sie of Appli .rrHee <br /> Date <br /> E P1DaYMlllyltlERPWWSygMEM pBU/�AR7JG171ptpp�pyph <br />