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APPLICATION FOR ENCROACHMENT PERMIT <br /> PLEASE PRINT: <br /> Date ( �A 3 OFFICE USE ONLY <br /> To: San Joaquin County JOB# J36&52-- ID REF# <br /> `` Department of Public \Works <br /> s APN CR# <br /> EXP.DATE 111 83 <br /> VALID fo y I� Y3 DRIVEWAYS: <br /> (Applicant Name) STREET v <br /> AREA I'X46q QUAD $W <br /> 1 i ►►�b �z- ��y Q�� � TYPE t u�. '5U ` <br /> (Mailing Address) FORMS 56 WU9 <br /> � J <br /> )4,,60o <br /> y (` � C�,(,. a NOTES <br /> (City,State,Zip Code) `� <br /> (Area Code-Telephone Number) <br /> Sketch(Detailed plans may be submitted) <br /> P o65-?3 <br /> 777�The undersigned hereby applies for permission to excavate,cLni�t and/or othe ise encr a` n County Highway Right-of-Way on <br /> the side of Wj � 1( approxima e y feet/mile <br /> of ,by performing the followin work(description of work): <br /> '�'01.�L-1 N�� S(.i���� ,p!-.�'►.1�1 �I ��� ��-C'�" ��'JS f..J�' �� <br /> VT fl. A lam <br /> A 1q-2 <br /> e <br /> 1 , <br /> Work will commence on or about_ for approximately days. <br /> 1,the undersigned ertify that l am the owner of the respective property,or am qualified to represent the owner and agree to do the <br /> work descr ed a #e in accordance with the rules and regulations of San Joaquin County and subject to inspection and approval. <br /> f <br /> "- ignatuiCVbf Af plica�Titl Date <br /> E:�PUB SV.1t7fdJ.ASTE?.PSIENCP.OACHIJENT PERI.IIT APPLICATION.DOC MOB) <br />