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APPLICATION FOR ENCROACHMENT PERMIT <br /> PLEASE PRINT: <br /> Date ! \1 A Z& [ - OFFICE USE ONLY <br /> To: San Joaquin County JOB# 73oo51-a REF# <br /> Department of Public Works APN CR# <br /> r EXP.DATE <br /> VALID !S y 0 DRIVEWAYS: <br /> (Applicant Name) STREET Vo ES ook ' <br /> AREAf=gr-WN1-20tpUAD ME <br /> TYPE oelk± ' <br /> (Mailing Address) FORMS Tts&W, -Z <br /> NOTES � <br /> (�1 r�,v ����� , CA.. 1-15� `>C. <br /> (City,State,Zip Code) <br /> -7 3C <br /> (Area Code-Telephone Number) <br /> Sketch(Detailed plans may be submitted) <br /> The undersigned hereby applies for permission to excavate,construct and/or otherwise encroach on County Highww Right-of-Way on <br /> the 5vu N side of C=2 approximately 5' ee mile RST <br /> Of P--c, C Rf-cc,k r`1 L M N by performing the followin work(description of work): <br /> Pjt_�— <br /> L5iLLL)Ti\ 'F—I Kyr \A;ti-L <br /> 16o' C,'1�t-(�: F-/T A, L K 57 t ZSCiUJ'rLL_ �!`` 3 0(F-F E/'P ?-.,"f-c=-Aux ) THS lLL 1S <br /> t\ NV 4' 0FV- E-/P; 3 LP i i-ty„1 tr L L'�L �'�U'` -Tni-PSL L&,,� Gi TH <br /> U? L&,GC'- 10-1– 2' <br /> Work will commence on or about S . ZD 1 Z for approximately 10 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-Title DefV <br /> f <br /> E%-LSSV WSTERPMR CROACH*-WP MTIPRiGTCNMC PILI <br />