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81 <br />ar <br />e{ <br />3, <br />k <br />=.h <br />igi <br />)n <br />PLEASE PRINT: <br />APPLICATION FOR ENCROACHMENT PERMIT <br />Date / _-15--ZJ <br />To: San Joaquin County <br />Departefolic Works <br />_0�6Lff <br />(Applicant Name) <br />(City, State, Zip Code) <br />U1 Z_ -Z- R� 3-e, <br />(Area Code -Telephone Number) <br />(Email Address) <br />JOB# <br />APN <br />EXR DATE <br />VALID <br />STREET <br />AREA <br />TYPE <br />FORMS <br />NOTES <br />OFFICE USE ONLY <br />730052 REF# <br />CR # <br />TO 6/15/2022 DRfVEWAYS: <br />"B" ST. <br />Stockton QUAD SS <br />Pole Replacement <br />SS/WVV <br />Special Conditions <br />Sketch (Detailed plans may be submitted) , _ V c - <br />T )r- ice ^ <br />N <br />y `v <br />The undersi ned hereby applies for pe ission to excavate, construct and/or otherwise encroach on County Highway Right -of -Way on <br />the _� side of S approximately rZsw Aeras � feetimile �J <br />Of 5'T by performing the following work (description of work): <br />Work will commence on or after 17--/ b- for approximately days. <br />sir i, the undersigned, certify that I am the <br />bE work described above in accerdan� <br />9+' <br />'e e ' arty, or am qualified to represent the owner and agree to do the <br />and regulations of oaquin County and subject to inspection and approval. <br />/Z -S-2,/ <br />