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APPLICATION FOR.ENCROACHrAENT PERMIT <br /> PLEASE PRINT_ _- <br /> / USE ONLY <br /> Date <br /> JOB# 1200425 - REF# <br /> To: San Joaquin County - <br /> Department of Public`Works <br /> ANP _ CR# ----- <br /> EXP.DATE 7 Z DRIVEWAYS: <br /> VALID 1?^ T ORo <br /> O _ _ <br /> L- _ <br /> - (Applicant Name) STREET —__ - <br /> j �G _.__ QUAD <br /> AREA - -_-- - _ - —- <br /> TYPE SAO AGt�t�lf�vc9�" k <br /> (Mailing Address) FORMS __ ___ _------------ - -- <br /> NOTES <br /> (City, State,Zip Code) -- <br /> - ----- <br /> (Area Code-Telephone Number) L - - <br /> Sketch(Detailed plans may be submitted) <br /> 17 <br /> I <br /> I <br /> The undersigned hereby applies for permission to excavate,construct andar otherwise encr 9 h0 County Highway <br /> feetimi eht-of-Way on <br /> NO M <br /> approximately ..� <br /> the : side of_ ._�-____.------_----__-- performing the follo4ving work(description of work): <br /> of P g Z� 0 <br /> 0 <br /> f�CP�4A'I�S21J- �'C��..A _._ a IJs'", ►J`. 1pt1..LP�►it�� O� 1,71 1-�-IIE`�r <br /> _ - <br /> -- iJAWw./1tC days. <br /> -- - ----- -- - - T:,r a roxirnatel <br /> - pP Y <br /> Work will commence on or about _ 2 <br /> ree to <br /> the <br /> I,th ndersigned,certify that I am the owner of the respective property, ° oactuinam jlC.Ioun'y-1-,ified to d subject to inspe'io esent the owner and and approoval. <br /> Vescribed, - in accordance vritl�the rul sand regulations <br /> Date <br /> Applicant-.Title <br /> i.�f;dl?f.Frtlt A�Y''. <br />