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a <br />APPLICATION FOR ENCROACHMENT PERMIT �() <br />PLEASE PRINT: <br />Date ( q ' <br />To: San Joaquin County Highway Department. <br />%Z (, Gt/ w N S T2 u Gr/DGJ <br />(Applicant Name) <br />85-4- o ,e12 <br />(Mailing Address) <br />s'/#- C C4, c�, -!,-- � Z & -' <br />(City, Stale Zip :ode) <br />7/4i -3t3 /k 77 <br />(Area Code - Telephone Number) <br />Sketch (Detailed plans may be submitted) <br />222 OFFICE USE ONLY <br />JOB # REF# _ <br />APN - - CRV# 7o– %� <br />EXP. DATE MG <br />VALID9 �S O DRIVEWAYS: <br />STREET ,ec �-A_ <br />AREA 4 QUAD C C <br />TYPE -5,e, <br />FORINTS 55& w 2 q <br />NOTE -Ez, e - <br />The undersigned hereby applies for permission to excavate, construct and / or otherwise encroach on County <br />Highway Right -of -Way on the side of approximately <br />feet /mile of , by performing the <br />following work: (description of work ): n <br />Work will commence on or about for approximately 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 described above in accordance with the rules, regulations of San Joaquin County and subject <br />to inspecti d approval. <br />SIGMA F APPLICANT - =E DATE <br />