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Litre �,i• <br /> APPLICATION FOR ENCROACHMENT PERMIT <br /> PLEASE PRINT: - G' <br /> Date 7T ,,;- 2- 'P' k i OFFICE USE ONLY <br /> To: San Joaquin County JOB# REF# <br /> Department of Public Works APN _ CR# <br /> EXP.DATE _ <br /> VALID to // DRIVEWAYS: <br /> (Applicant Name) STREET <br /> AREA QUAD <br /> TYPE rr7Crt <br /> (Mailing Address) FORMS <br /> NOTES <br /> 4V , t,�-- ys-��f _ <br /> (City,State, Zip Code) _ <br /> (Area Code-Telephone Number) _ <br /> Sketch (Detailed plans may be submitted) <br /> (vtft Wo I <br /> The undersigned hereby applies for permission to excavate, construct and/or otherwise encroach on County Highway Right-of-Way on <br /> the AJ-P-"-,q _side of (2./ approximately 6-cv feet/mile <br /> of n .a j-^ R d , by performing the following work(description of work): <br /> Work will commence on or about 11 for approximately 2 days. <br /> I,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 ove in accor ance with the rules and regulations of San Joaquin County and subject to inspection and approval. <br /> 1 <br /> � s <br /> �, <br /> 5 .y,o, I1 <br /> Signa une Appl ant-Title Date <br /> E WUBSVWKNMSTERPMENCROAC IMENT PERMIT APPL[CATION.DOC (01 AA) <br />