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APPLOATION FOR ENCROACH VOr PE.ICHIT <br /> PLEASE PRINT: <br /> OMA CE USE ONLY <br /> Date JOB #' 7,3077 REF# <br /> APN - CRV# <br /> To: San Joaquin County Highway Department. EXP. DATE 12,-13619, <br /> «IL/r-!�! 7,,- Z��6/�!//C,� �C� STREET VALIDAr Z /?-/3e)/'7j—DRIVEWAYS: <br /> Z ,3� t �vAYs: <br /> y <br /> (Applicant Name) AREA STA--,f QUAD . �S <br /> 14/-'=L�1P//Ol 257- TYPE- <br /> FORMS <br /> YPE-FORMS <br /> (Mailing Address) NOTE <br /> (City, State Zip Code) <br /> (Area Code-Telephone Number) AV-1-Z46). <br /> Sketch(Detailed plans may be submit4,.4 fCL'%. iYo_ /� C 0 <br /> r T CA <br /> RIEN VO A) <br /> M <br /> r - _ <br /> -p -r <br /> r j <br /> o � <br /> The undersigned hereby applies for rmission to excavate construct d/or otherwise encroach on County <br /> Nsghway Right-of-Way oa e side of �G+J L D approximately <br /> /� C feet I mile of �'U, rf2-t= ,by performing the <br /> following worm: (description of work): l2/E 60 i// /tel )10's Aq-// Al <br /> • �� 2E1 l2� 4 <br /> Work will commence on or about /O - a - .S for approximately --In _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 inspection and approval. <br /> - 2 S^ <br /> SIGNATURE OF APP ICANT - TITLE, DATE <br />