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PPP <br /> APPLICATION FOR ENCROACHMENT PERMIT <br /> F}-E SNO <br /> PLEASE PRINT: C-)k I)lDPD <br /> Date --�' -11� - olle OFFICE USE ONLY <br /> To: San Joaquin County JOB# 7.70652 �' REF# <br /> Department of Public Works APN CR# <br /> EXP.D <br /> VALID ATE ID 1Zl r 0 1 f J5 DRIVEWAYS: <br /> (Applicant Name) STREET Q RP, g <br /> p <br /> Pac <br /> AREA i�ANTGCA QUAD E <br /> _. TYPE <br /> (Mailing Address) FORMS <br /> (`-� NOTES T� <br /> -4,�7 <br /> (C y, State,Zip Code) <br /> (Area Code-Telephone Number) <br /> Sketch (Detailed plans may be submitted) <br /> PM <br /> The undersigned hereby applies for permission to excavate, construct and/or otherwise encroach on County Highway Right-of-Way on <br /> the side of approximately feet/mile <br /> of , by performing the following work(description of work): <br /> ZQ5 2�eVLtAoaE Ad AW 4l70 s AAMYXr h L.'?r//� <br /> 61 %W A2r•31N 5T /l; d <i rbc ;V 6"Ken Ale)zrb Indlev Ale-. <br /> ,J z <br /> c;/le m &w&kAn 51% •rr, G&A 2,,,P 4-1, --,,-AJwP v - <br /> Work will commence on or about � 11a for approximately_��i���-�s 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 above in accordance with the rules and regulations of San Joaquin County and subject to inspection and approval. <br /> Signatur •of Applicant-Title Date <br /> E:1PUB-SV.WKIMASTER.PSIENCROACHMENTPERMITAPPLICATION.DOC (01)08) <br />