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APPLICATION FOR ENCROACHMENT PERMIT <br /> PLEASE PRINT: CC / `' <br /> Date +- l J. — `�c OFFICE USE ONLY <br /> To: San Joaquin County JOB# REF# <br /> Departmento IM <br /> APN CR# <br /> - _ ` EXP.DATE <br /> t O i IP-+�^ L 5 C VALID TO DRIVEWAYS: <br /> (Applicant Name) STREET <br /> U`� AREA QUAD <br /> w c 1\4\'L-2 [�--c.p TYPE ` <br /> (Mailing Address) FORMS <br /> NOTES <br /> ity,State,Zip Code) <br /> 6�a-�- —3c-- !I <br /> (Area Code-Telephone Number) <br /> Sketch(Detailed plans may be submitted) pro 0 <br /> �j 45::�Nv'ls;,k4 L., 10, Du I-'#AX'L' <br /> j J !;r/( 4 / / <br /> J G,�c^✓vf�o��l <br /> The undersigned hereby applies for permission to excavate,construct and/or otherwise encroach on County Highway Right-of-Way on <br /> the side of approximately feet mile <br /> Of - ,by performing the following work(des(ription of work): <br /> ��1.. �•.�-�-/oyi Gr/f l l ,,f�,gcJ� f..l„sff- <br /> r <br /> Work will commence on or about for approximately days. <br /> i <br /> I,the undersigned,certify that )wner of the respective property,or am qualified to represent the owner and a!Iree to do the <br /> work described`above ccordance wit the rules and regulations of San Joaquin County and subject to inspection a id approval. <br /> Si nature of Ap 'cant-Title Date <br /> AIACENIRALSERVICMCLEFUCAL1Fi185V.WMASTER.PStENCROACHMENTPERMI(APPUCATIONAOC(09113) <br />