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APPLICATION FOR ENCROACHMENT PERMIT <br /> PLEASE PRINT: <br /> OFFICE USE ONLY <br /> Date !� / `!' / '1' -- <br /> J08# �7? CR# <br /> To: San Joaquin County APN <br /> Department of Public Works EXP.DATE V <br /> + <br /> T <br /> O DRIVEWAYS: <br /> VALID <br /> STREET N AaCUD <br /> pplicant Name) AREA r- QUAD <br /> TYPE <br /> FORMS �51N <br /> NOTES — <br /> (City,State,Z p Code) <br /> (Area Code-Telephone Number) <br /> FSketchetailed plans may be submitted) AT,�,y L/AtGoGA✓ eeE&76_) e. SR`c�pL EYES-/tl aE ��''�''✓L' DUB/Hila 7%�r43'Gt.�E <br /> ' lies for�rmission to excavate,construct and/or otherwise encroach County Highway <br /> feetlmi eht-of�Way on <br /> The undersigned hereby app 171)1-7- j2j approximately <br /> the f,/ side of %� f �' '' ,by performing the following ork(description of work): <br /> Of <br /> � for approximately <br /> L _days. <br /> Work will commence on or about— nd ree to do the <br /> I,the undersigned,certify that I am the owner of the respective property,or am qualified to represent the owner aag <br /> work described above in accordance with the rules and regulations of San Joaquin County and subject to inspection and approval. <br /> Date <br /> f`1 <br /> Ti . <br /> SignaApplrcan <br /> EY'JBb'/WKWASIERP9ENCR0ACHMENM PERMR APPUCAiION..DOL(0108) <br />