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APPLICATION FOR ENCROACHMENT PELT <br /> PRNVT• <br /> Date <br /> OFFICE USE ONLY <br /> To: San Joaquin County JOB# <br /> Deparbrnent of Public Works APN REF# <br /> l� /s <br /> EXP.DATE CR# <br /> S"/I <br /> (ApPlicant Name) j VALID ¢� 0 <br /> STREET DRIVEWAYS: <br /> —7 AREA QUAD <br /> (Ming Address) TYPE '5tC G,aetl S• <br /> FORMS <br /> 64 � o70(a NOTES <br /> (City.State,Zip Code) <br /> 50 353- 6 vg's <br /> Was Code-Telept m Nim ) <br /> Sketch(Detailed Plans my be s mined) <br /> 4-ITA C441EL <br /> The hereby applies for Permit,to excavate,caps <br /> S side F -t,,Q,_ °thy en«oach on County Highway Right-of-way on <br /> K <br /> R 1by the following work Of <br /> f�m�_&2ggr14 <br /> _ ( bion of work): <br /> d SZ ItT' <br /> ------------- <br /> Work wiN cOmmenoe on or about <br /> for VWN parr .� <br /> I.the u days. <br /> signed,oe*that I am the owner of the respective property,or <br /> am w described above in acxordance with the rules and ui qualified to represent the owner and agree to do the <br /> reg ations of San Joaquin County and subject�inspection and approve. <br /> Of�Applk�* "�.Tkw <br /> e.wsvNnaw�c�epa.eavenn,�:uanMooc,o„oy Date <br />