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APPLIPATION FOR ENCROACHMAT PERMIT <br /> PLEASE PRINT: <br /> Date -730 '7 <br /> OFFICE USE ONLY <br /> JOB # 73 0 7 7 REF# <br /> APN CRV� <br /> To: San Joaquin County Highway Department. EXP DATE <br /> /2 VALID /a fr TO / e DRIVEWAYS: <br /> STREET �.�i�vG�y-a,tiry25 # <br /> (Applicant Name) AREA ST,Cti/ QUAD C c <br /> TYPE_ /mss- <br /> FORMS <br /> (Mailing Address) NOTE <br /> (City, State Zip Code) <br /> 1-209- <br /> (Area Code-Telephone Number) i -1-Z1e;-Y11O/V/16. -�2- <br /> Sketch(Detailed plans may be submitted) frCLT. V,_ /(3 6 -9/ <br /> c� cert <br /> c <br /> - <br /> Ci < <br /> m <br /> CD 0C= <br /> The undersigned hereby applies for <br /> � y pp permission to excVafe, construct d/or otherwise encroach on County <br /> I-N.ighway Right-of-Way on the _side ofn j� C-6 -f-0-o appro;timately <br /> /©v feet /mile_A� of ��/ TZ ,by performing the <br /> Mowing work: (description of work): <br /> ' c <br /> Work will commence on or about -,,2- 9 for approximately 3'n —days. <br /> I the undersized 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 inspection and approval. <br /> SIGNATUTRE OF APPLICAINT - TITLE. <br /> DATE <br />