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AP t 0 CAT'ION FOR ENCROACHAP, NT PE1011T <br /> PLEASE MUNI': <br /> OFFICE USE ONLY <br /> Date J -/7-�5 JOB #,73 6 2 o REFti <br /> APIN _ _ CRV# <br /> To: San Joaquin County Highway Department. Ems, DATE/o / <br /> tilr1LID Q 9S O DRIVEWAYS: <br /> STREET <br /> (Applicant Name) AREA .*;;'r.l QUAD 11W s <br /> _ TYPE ,80A <br /> FORMS ss .tin�� ,e-29 <br /> (IN ailing Address) NOTE <br /> (City, State Zip Code) <br /> '(Are�0 ?- el — y'9- <br /> (Area <br /> a Code -Te1cphone Number) <br /> Sketch (De4,::led pla s:nay subrm/' dam�) <br /> 1z:7 co <br /> CA <br /> C=) r' ' <br /> 'co . <br /> � 0 <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 /> Leet I mile�_ of ' e , by performing t <br /> following Nvork: i description of Nvork j: <br /> 114- o ,1f�, L�/z�i L�1r'�e cs� / %j el y�Cz cs o�Li es/&0' <br /> work-will commence on or about /O -- L���' for approximately_�_days. <br /> I the undersigned certiN that I am the owner of the respective property, or ani qualified to represent the owner c <br /> agree to Flo the work describcd above in accvrdtmcc with the rules, regulations of San Joaquin County and subs <br /> to n and approval. <br /> o �o2 <br /> SIGNATUrOF APPLi ..�t�iT - =E' DATE <br />