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APPLICATION FOR ENCROACHMENT PERMIT <br /> PLEASE PRINT: <br /> Date I Z r j OFFICE USE ONLY <br /> To: San Joaquin County JOB# REF# <br /> Department of Public Works APN CR# <br /> t ` C EXP.DATE W- /, <br /> VALID 2/11/14 TO DRIVEWAYS: <br /> (Applicant Name) STREET <br /> AREA UAD <br /> TYPE t <br /> (Mailing Address) FORMS s Will <br /> \\ <br /> G �j NOTES <br /> J 1 �f <br /> (City,State,Zip Code) <br /> (Area Code-Telephone Number) <br /> Sketch(Detailed plans may be submitted) iv r' ?L 1 Old F74 <br /> 11�CJ 1Dj� <br /> > <br /> The undersi ned hereby applies for permission to excavate,construct and/or otherwise encro�CountyRight-of-Way n�� deof `' �` �approximately j(_ mileof ={E� 1L hS"' �Nt+ by performing ription of work): <br /> G <br /> A� Ih-T—)AL44 -Z .vv I ky . + 7 s - T-4 A I <br /> 'TU <br /> t45-C)"-fi VCf-41::-Y Wt u7S . <br /> Work will commence on or about A 1Ji for approximately days. <br /> I,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 describe b ve in accordan "th the rules and regulations of San Joaquin County and subject to inspection and approval.. <br /> � l Z ¢ <br /> Sig , of n -Title Date <br /> VPU65V.V:IC,"STEcLPR=14CP.OACNNQlTPRLff APPLICA�OHDOC(01x74) <br />