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APPLICATION FOR ENCROACHMENT PERMIT <br /> PLEASE PRINT: S y l !�,� 50 <br /> Date I e IS- 14 f j OFFICE USE ONLY <br /> To: San Joaquin County JOB# I t O Q O 7 REF# <br /> Department of Public Works APN CR# <br /> EXP.DATE <br /> CQ►A.(C,�4ST <br /> L <br /> JV CO VALID TO DRIVEWAYS: <br /> (Applicant Name) STREET <br /> AREA D <br /> �3qy TYPE _15J� t 66,lea <br /> ''t <br /> (Mailing Address) FORMS y Sy/Ir/ <br /> NOTES <br /> Q VG 112-+I026 CA l44:560 <br /> (City,State,Zip Code) <br /> i��ta5) -78,3^1/9-77 <br /> (Area Code-Telephone Number) <br /> Sketch(Detailed plans may be submitted) 5C6" A.T—,4 W6b <br /> The undersigned hereby applies for permission to excavate,construct and/or otherwise encroach on County Highway Right-of-Way on <br /> the 50wrw side of E- XCFMZAUt3 LtJ approximately X300 ' Q22 rile 46T <br /> of S. i EG1L ,A N TL s L ,by performing the following work(description of work): <br /> 1_"Frfr t c CO K.)^2o t� 'ro P4-AC6 CA� O&D 4_0(AU7_ Pof-6S. <br /> Au. r4a62r su I t.c. Ted k& PIZ-AC6- 01Q 5 t/OGi .b6L, <br /> Work will commence on or about — 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 described above in accordance with the rules and regulations of San Joaquin County and subject to inspection and approval. <br /> J&� L�i2H1i7' C6o2��N,d� /' 15 /V <br /> /',;Tature of Applicant-Title Date <br /> M:ICENTRALSERACESICLERICALIPUB-SV.WNIMASTERPSIENCROACMENT PERMIT APPLICATION.00C(09113) <br />