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PLEASE PRINT: <br />APPLICATION FOR ENCROACHMENT PERMIT <br />Date a Z- % 0.3 / �7 <br />To; San Joaquin County <br />Department of Public Works <br />(Applicant Name) <br />4040 WEST LN <br />(Mailing Address) <br />STOCKTON, CA 95204 <br />(City, State, Zip Code) <br />408-316-1767 <br />(Area Code -Telephone Number) <br />Sketch (Detailed plans may be submitted) <br />SEE ATTACHED SKETCH <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 lU • l�� � ! S 2 l� approximately Z- 6 9 r fe mile-Scx�f+� <br />of P& L Ti iEK /;2b L aoby performing the following work escription of work), <br />iE xe,Par c>.4sA� t y _je Y" 13e%/ //otif 00 Dlrt AIVO 13o2/=T - <br />L4 P %1 y opt u�raS� f -o insg// 6ya-s SP, -y i c P <br />Work will commence on or about OZ Z 7 for approximately / DC7 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 ab ve in accordance with the rules and regulations of San Joaquin County and subject to inspection and approval, <br />�7 <br />Si <br />of Applicant -Title <br />E:NUB-SV.WKIMASTERPSIENCRCACHMEIJ�PERMRAPPLICATICNACC (01N8) <br />Date <br />OFFICE USE ONLY <br />JOB# <br />%� REF# <br />APN <br />CR # <br />EXP. DATE <br />—% f 47 <br />VALID <br />3-15-1 TO I -(f J7 DRIVEWAYS; <br />STREET <br />x <br />AREA <br />QUAD x <br />TYPE <br />r.p. /1ho Le <br />FORMSf <br />S �/ li/ <br />NOTES <br />:'Q�?G� <br />Sketch (Detailed plans may be submitted) <br />SEE ATTACHED SKETCH <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 lU • l�� � ! S 2 l� approximately Z- 6 9 r fe mile-Scx�f+� <br />of P& L Ti iEK /;2b L aoby performing the following work escription of work), <br />iE xe,Par c>.4sA� t y _je Y" 13e%/ //otif 00 Dlrt AIVO 13o2/=T - <br />L4 P %1 y opt u�raS� f -o insg// 6ya-s SP, -y i c P <br />Work will commence on or about OZ Z 7 for approximately / DC7 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 ab ve in accordance with the rules and regulations of San Joaquin County and subject to inspection and approval, <br />�7 <br />Si <br />of Applicant -Title <br />E:NUB-SV.WKIMASTERPSIENCRCACHMEIJ�PERMRAPPLICATICNACC (01N8) <br />Date <br />