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'. 31 <br /> APPLICATION FOR ENCROACHMENT PERMIT <br /> PLEASE PRINT: <br /> Date q19 7 /J <br /> Lf OFFICE USE ONLY <br /> To: San Joaquin County JOB# REF# <br /> Department of Public Works APN CR# <br /> EXP.DATE <br /> VALID TO DRIVEWAYS: <br /> (AppUcant am STREET <br /> STREET <br /> e�p^d�c'" pear AREA QUAD <br /> 1`14'or l�r4< PIA TYPE <br /> Address) FORMS <br /> NOTES <br /> (City,State,Zip Codey <br /> 114- 7�0 ^g8 � 2 <br /> (Area Code-Telephone Number) <br /> Sketch(Detailed plans may be submitted) <br /> i <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(description of work): <br /> 6C- . II .e ti a v 1 <br /> Work will commence on or about Y/-f — c 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 j <br /> work described above in accordance with the rules and regulations of San Joaquin County and subject to inspection and approval. <br /> SjOiraffiure of Applicant-Title Date <br /> M10Ett WSERVICEStCLERICALIPUS-SV.tYNWASTER.PSI£NCROACHMEtITPERA4TAPPL)rAT10tl DOC(OW13) <br />