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'fid<- 6Ll Q' <br /> APPLICATION FOR ENCROACHMENT PERMIT <br /> PLEASE PRINT: <br /> Date OFFICE USE ONLY <br /> To: San Joaquin County JOB# REF# <br /> Department of Public Works APN CR# <br /> EXP.DATE <br /> co 1z.1 j .J I� I r�` VALID TO r /3 DRIVEWAYS: <br /> (Applicant Name) , i - STREET ��fn�� <br /> AREA f /� QU <br /> -�a� �► I G I I�(Xc Cry ? J'�illj � TYPE OT' 10z <br /> (Mailing Address) FORMS OKPI ' raj f�f <br /> NOTES <br /> (City,State,Zip Code) <br /> y . 24 'S�zr) <br /> (Area Code-Telephone Number) <br /> Sketch(Detailed plans may be submitted) <br /> IfUlff AKE) <br /> tL 0Q0 L -FLAQs <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 performi the fo�llowi wo K k ae iption of work <br /> C i lig n1 � ma <br /> Li ptmo p � 1 <br /> Work will commence on or about for approximately 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'n accordance with the rules and regulations of San Joaquin County and subject to inspection and approval. <br /> r <br /> Signatu f pp ican - Date <br /> E:1PU6-SV.WKIMASTER.PSIENCROACHMENTPERMIT APPLICATION.DOC (01/08) <br />