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APPLICATION FOR ENCROACHMENT PERMIT <br /> PLEASE PRINT: <br /> Date <br /> 3 � a� 11e� <br /> •• OFFICE USE ONLY <br /> To: San Joaquin County. JOB _730(S 2— REF <br /> Department of Public Works APN CR# <br /> D' rr_ _ ,__ /� EXP.DATE — — <br /> lJ � 1 $fk ok VALID — I cf'-1 TO DRIVEWAYS: <br /> (A plicant Name) STREET f x <br /> �a AREA L QUAD 4 — <br /> g� <br /> we S1 Sg "'N'11-' TYPE x <br /> (Mailing Address) FORMS /1" <br /> NOTES <br /> (City,.State,Zip Code) <br /> (Area Code-Telephone Number) <br /> Sketch(Detailed plans may be submitted) <br /> c. <br /> i <br /> The undersigned hereby applies for permission to excavate,construct and/or otherwise encroach on.County Highway Right-bf-Way on <br /> the side of approximately' feetlmile <br /> of ,by performing the following work(description of work): <br /> o c�4-e //, i t { /,,z re da,t f� Wb(6 1a C.C. �e d0--% `yam . <br /> he rtpkc.ed t .K +!1.+ s Atm ga 6. <br /> Work will commence on or about Sly— JU I I I`- 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 /> ignature of pplicant-Tide Date <br /> ESPUS-SV.UIKU.'ASTER.PSIEHCRDACMJ.EIrTPEFJARAPR.ICATIDR.DCC(0108) <br />