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APPLICATION FOR ENCROACHMENT PERMIT <br /> PLEASE PRINT.- <br /> Date <br /> RINT:Date <br /> OFFICE USE ONLY <br /> To: San Joaquin County JOB# 19 00 M, 6 REF# <br /> Department of Public Works APN 11 CR# <br /> EXP.flATI: <br /> VALID 1 I A. TO j DRIVEWAYS: <br /> ' (Applicant Name)Oz <br /> STREET 1E N <br /> ��= AREA 7`�Z��'� QUAD ."rttJ <br /> TYPE Its . <br /> (Mailing Address) FORMS _ <br /> /1 ;7 .-- NOTES <br /> (City,Sate,Zip Code) <br /> (Area Code-Telephone Number) <br /> Sketch(Detailed plans may be submitted) <br /> i <br /> The and s1 ned�l ereby appliesZorer_m�'ss_lan toxcavg,atp�,construct and/or otherwise enc ac onCountyHig Right-of Ulna on <br /> the �`� sIdeof "� �`C" 7 Y <br /> approximately <br /> of pp Y fee iia _ <br /> by performing the following work ascription of work): <br /> i <br /> Work will commence on or about for approximately <br /> 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 desr'bed above In ac Qance with the rules and regulations of San Joaquin County and subject tains action and approval. <br /> royal. <br /> p <br /> ,f Signa roof plicant-Title <br /> .�' Date <br /> •`EW35Y1hSt(�STERPSQ;�RGSQ4[r?.TPERl1fTdPPl7CATF0A100C�1F:5] . <br />