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APPLICATION FOR ENCROACHMENT PERMIT <br /> PLEASE PRINT: <br /> - OFFICE USE ONLY <br /> Date c1 JOB # REF# .. <br /> APV $ - d 7 b - CRV# a 7l 8s— <br /> To: San Joaquin County Highway Department. E)M. DATE <br /> VALID TO DRIVEWAYS: <br /> o} i 6,L 1c,1= - STREET- <br /> Name <br /> (Applicant ).- :_:-- :; -., AREA..�7-2G�1=>-.,-'--- QUAD•==►�1_ ._,, - .r, <br /> _�. _._. _. TYPE�1? <br /> i - — <br /> J FORMS <br /> (Mailing Address) <br /> NO'T'E <br /> (City, State Zip Code) <br /> (Area Code-Telephone Number) --- <br /> Sketch(Detailed plans ria-.,,,by submitted) <br /> ---7-7-7 <br /> The-undersigned hereby applies rmission to e�cyate, constntct and/or otherwise encroach on County <br /> Highway-R;04--,of-Way. on the side_Qf G L L ^/ '` ` -`approximately <br /> 1 0 0:rfeet l rfille 5 4u'ru. of ._moi .-.ET �--� i e_ & 4*r-4 ; by perforn g the <br /> following tivor :(description of work j: D 2 IV-c-w ,4 gad <br /> Work will commence on or about l 1 A c q� 5 for approximately { �__._ days. . . <br /> I the;undersig�ned certify that.I am-the-owner of.the respective.property,or am qualified to represent the owner and <br /> agree to do lha work de—icnbed abovs in aacordarice tivith the rules,regulations of San Joaquin County and subject <br /> to ins pep tionadi <br /> d approvt . <br /> GNT,TURF OF-APPLICANT TITLE DATE <br />