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Lo <br /> APPLICATION FOR ENCROACHMENT PERMIT <br /> PLE-ASEPRiNT- <br /> Date OFFICE USE ONLY <br /> 9 REF <br /> 0: San Joaquin CountyJOB -A, e %� <br /> APM CR#. <br /> Department of Public Works <br /> .EX.P.DATE 9 -- <br /> DRIVEWAY'S <br /> le(4 04 .VALID b G.l2--l' <br /> STREET &-)v\ 1� <br /> (App!cant Named M�EA. QUAD <br /> 0R.p4-&-Aj pet 553=— , <br /> TYPE <br /> (MOI ing Address) FORMS U.? <br /> NOTES <br /> 0- 01 <br /> (city,State,Zip Code) <br /> 7(o <br /> (Area(;o.cle-I elephorib NU.rhb <br /> 01ch(Oet lied plans may be submitted) <br /> 4-e, *4 <br /> The, <br /> he an ersl.gned hereby applies for permission't0 excavate,construct and/of0therwise encroach on Cfianty H11ghw.'.y k1ght-ofWay on <br /> ed M116 <br /> approximately % <br /> the W6rk(description wo <br /> Id b,�pe'ifoirir Ing f(AlAini f rk), <br /> of <br /> 4, FNJ <br /> for approAlmat.dy, days, <br /> \/Vofk will commence on,or about <br /> the owner AM agree to do the <br /> the:owner of the resppolivo'propQrty,or am qualified to represent 1,the undersigned,00ify that I pm. <br /> work described above in octordahoo with the rules and tdgulatlon.s Of San Joaquin Couhty and subject to ihspebt[On EM'6PPrO01. <br /> //Z— <br /> Si �Aporwihl-Title gate <br />