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APPLICATION FOR ENCROACHMENT PERMIT <br /> PLEASE PRINT: <br /> Date 9/�°�`� OFFICE USE ONLY <br /> To: San Joaquin County JOB# f 90085 REF# <br /> Department of Public Works APN _ CR# <br /> EXP. DATE <br /> / yJ�✓SSG /r7 VALID o 0 2 / /s DRIVEWAYS: <br /> (Applica t Name) STREET <br /> AREA Sj3c tr6 QUAD 05 <br /> gdfo�S /YCGIl/D/�I Vii!G( TYPE //ops ruc�l ✓ �G Go ✓ <br /> (Mailing Address) FORMS �e,„� ,;� 14/,--� <br /> NOTES <br /> (City, State,Zip Code) /,per a �7" �9/,�S l?}VA/ <br /> �.1sss'iG�,t�v,�zgL �,�Jry /� l�o�tr✓ <br /> (Ared Code-Telephone Number) <br /> Sketch(Detailed plans may be submitted) <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 /> /� YO�.+O�T' .�E/siQ�,r2 !i/iT�1�.�/ TSE F�gsrsi0� .�i.�L `ryrY�/,� ��'orEcr�✓ <br /> Work will commence on or about /a / /4 for approximately �l4-5- W. <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 /> wor described a ve in accordance with the rules and regulations of San Joaquin County and subject to inspection and approval. <br /> Sign scant-Title Date <br /> YAFORMS 8 TEMPLATESIENCROACHMENT PERMIT APPLICATION x(08/08) <br />