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MGA e--Ile <br /> APPLICATION FOR ENCROACHMENT PERMIT <br /> PLEASE PRINT: <br /> Date q- / 2- - j y OFFICE USE ONLY <br /> To: San Joaquin County JOB# 110005 REF# <br /> Department of Public Works APN CR# <br /> EXP.DATE ( I-I S -1 <br /> C 14 q-15 _Pr-Y ASl�-�� VALID 0-7- 4 TO 1 I-15-14 DRIVEWAYS: <br /> (Applicant Name) STREET E 004LJCAP kc{ <br /> AREA C4 M.0 QUAD <br /> 53go 43,'!,54 ST, TYPE <br /> (Mailing Address) FORMS S S I,/6/ R2� <br /> NOTES <br /> G4 141550 <br /> (City,State,Zip Code) <br /> 4 Z S� ? � - �''T-37 <br /> (Area Code-Telephone Number) <br /> Sketch(Detailed plans may be submitted) <br /> ATTAG419> <br /> The undersigned hereby applies for permission to excavate,construct and/or otherwise encroach on County Highwa Right-of--Way on <br /> the Al o 7-T N side of E. Woo*bBR4D6& tZD . approximately 70o ee ile W661- <br /> of N_ R'D , f4 G14"?o ,by performing the following work escription of work): <br /> 80e_e *'-2o 0/,)T "PoL' /M -bi IzT To sI—orAvT -Pd L9 <br /> Work will commence on or about 10- la- t q for approximately 15 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 /> `3igrhature of Applicant-Title Date <br /> �yss3� <br /> Y10EN1PAL5EFN10E9C[£RIGlM&SV WIIUMSIER PSENCRpAp14ENiPERW177PRIG1TgN OOC 10131 <br />