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r. <br /> APPLIC`CON FOR ENCROACHMEER1IT <br /> PLEASE PRINT: <br /> OFFICE USE ONLY <br /> Date JOB # .3��`�' REFH <br /> APN - - CRV9 <br /> To: San Joaquin County Highway Department. EXP. DATE 5 <br /> VALID DRIVEWAYS: <br /> STREET <br /> (Applicant Name) AREA (1 AD G G <br /> TYPE <br /> FORMS <br /> (Mailing Address) NOTE <br /> ��TOC�TDN, 1.9. 95ZaZ <br /> (City, State Zip Code) C <br /> /-209- �lo� 1q, D <br /> '81�f /1 ' X �'2.c <br /> (Area Code-Telephone Number) 11.�IIOZ16�r�oiv/y 7 .3 <br /> Sketch(Detailed plans may be submitted) i9CC77 IV,- 0 <br /> 2-4w <br /> The undersigned hereby applies for pe ' sion to exca te,construct and/ otherwise encroach on County <br /> Highway Right-of--Way on the�side of �-' ,(-J Vit- PPreximately <br /> 5—feet /mile _ of iv ,by performing the <br /> following work: (description of work): ' <br /> e 17) EE, s j <br /> Work will commence on or about �,5 - 3 - S for approximately To days. <br /> I the undersigned certify that I am the owner of the respective property,or am qualified to represent the owner and <br /> agree to do the work descri-bed above in accordance with the rules,regulations of San Joaquin County and subject <br /> to inspection and approval. <br /> SIGNATURE OF APPLICANT - TITLE DATE <br />