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APPLICATION FOR ENCROACHMENT PERW61T <br /> PLEASE PRINT: <br /> Date <br /> OFFICT:USE ONLY <br /> To: San Joaquin County JOB REF# <br /> Department of Public Wod(s APN -15() -1-40-P CR# <br /> EXP.DATE <br /> J, VALID <br /> TO DRIVEWAYS: <br /> --intmarne) STREET <br /> P 0 7 AREA QUAD <br /> TYPE <br /> (Mailing Address) FORMS .... . . .... <br /> NOTES <br /> (City,State,Zip Code) <br /> (Area Code-Telephone Mummer) <br /> Sketch(Detailed plans may be submitted) <br /> The undersigned hereby applies for permission to excavate,construct and/or otherwise encroach on County Highwa Right-of-Way on <br /> the Nor fk\ side of—) approximately_ .> 5( <br /> of eeV ile_4Ze� f <br /> seni <br /> by performing the following work((Oescnp:tion of wort( <br /> I 1 ''11 111 i0vol <br /> 51 (; P- f rl 1 41 <br /> 04 <br /> -±L- la r,-1A Ile eati 14LI,st <br /> Ide Chgl'�'MIZ4 <br /> Work will commence on or about <br /> for approximately days. <br /> 1,the undersigned,certify that I am the owner of the respective property,or am qualified to represent the owner and agree to do the <br /> work described above in accordance with the rules and regulations of San Joaquin County and subject to inspection and approval. <br /> 11211 <br /> Signature �Apprlca�Wj-Tlt�leDate <br /> tA'ICENTR1LLSERVICE=LEPJCALIPUB-SVWKIfAAsTERPSeCROACH,MFt4TPERLIITAPPLICA-n0N.D00(09M) <br />