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---- --- <br /> APPLICATION FOR ENCROACHMENT PERMIT <br /> PLEASE PRINT, <br /> Date 7-2D- 11 OFFICE USE ONLY <br /> To: San Joaquin County JOB# z—gyp REF# <br /> Department of Public Works APN CR# <br /> V/ 4 E EXP.DATE <br /> VALID TO DRIVEWAYS: <br /> t (Applicant Name) STREET we, <br /> AREA T L41 TYPE G�ifGTL� QUAD Al <br /> (Mailing Address) FORMS <br /> L A 175204 NOTES <br /> (City,State,Zip Code) <br /> (Area Code-Tel hone Number)- <br /> Sketch(Detailed plans may be submitted) <br /> The un ersigned hereby applies for permission to excavate,construct and/or otherwise en roach on County Highway Right-of-Way on <br /> the X71I side of / c 449.41iCt7. approximately ;b __._ feetGeile <br /> off RF-'Vr isiG ;a3a+yz ,by performing the following work(description of work): <br /> Work will commence on or about ( — '� for approxi mately days. <br /> 1,the undersigned,certify that I am the owner of the respective property,or am qualified to represent the owner and agree to do the <br /> work described above in accordance with the rules and regulations of San Joaquin County and subject to inspection and approval. <br /> Signature of Applicant-Tithe Date <br /> ppu-Sv.WKWSTER.PSWNCROACRMENT PERWT APPLICATION DOC MIMI <br />