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APPLI*ION FOR ENCROACHM A PE.RMUT <br /> PLEASE PRINT: <br /> %D -// - 9 S1JOBff <br /> OFFICE USE ONLY <br /> Date <br /> 73 0 7 7 REF# <br /> APN - - CRV# <br /> To: San Joaquin County Highway Department. Exp, DATE <br /> �fIL/`ITJJTG/Z Sb/�Gl/C� �C� VALID io TO DRIVEWAYS: <br /> STREET O/�y�,� R- <br /> (Applicant Name) AREA 5r*IV QUAD X S <br /> 4444 z.L L/ ,P/�Ol -!5T TYPE°1oe---' <br /> FORMS ss/cv w, ,e-Zy <br /> (Mailing Address) NOTE <br /> (City, State Zip Code) <br /> /-205 cl- S/l��/--�31// i9D.L�/lfr SS- <br /> (Area Code-Telephone Number) 19i"�"L/lyT1D/V 4105. <br /> Sketch(Detailed plans may be submitted) If C,1`77 IVo- <br /> F_S5 1410. •S`� 7 S <br /> rT CA ., <br /> / <br /> M <br /> r 'p r <br /> C) fV <br /> u, r.7 <br /> i The undersigned hereby applies for permission to excavate, construct and/or otherwise encroach on County <br /> Highway Right-of-Wayon e � side of / c �w�a.+7 approximately <br /> -�-0 feet /mile A) ofTc E /_-'E ,by performing the <br /> following work: (description of work): SLR d <br /> ' <br /> Work will commence on or about 16 - / 7- 9 .5- for approximately ZD days. <br /> I the undersisped 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 /> SIGNATURE OF APPLICANT - TITLE. DATE <br />