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APPLICATION FOR ENCROACHMENT PERMIT <br /> PLEASE PRINT: <br /> Date q _18_24DA <br /> To: San Joaquin County-Highway Department OFFICE USE ONLY <br /> JOB# 7 3 Z REF# <br /> P(So jel APN - - CRV# <br /> (Applicant Name) EXP. DATE -3( <br /> «Z`4 1f , ( �. eZ*e, 9 . VALID [ TO DRIVEWAYS: <br /> (Mailing Address) STREET E River <br /> N1 <br /> c, AREA QUAD S C.� J?J � TYPE $fJJ A FORMS SS k/ Z <br /> (City, State, Zip Code) NOTE <br /> (Area Code—Telephone Number) <br /> Sketch (Detailed plans may be submitted) PL a IA E 1Z_&1-eA`d_-# em -31099 9 24 <br /> A�C� J h <br /> The undersigned hereby applies for permission to excavate, construct and/or otherwise encroach on <br /> County Highway Right-of-Way on the n. side of E , Ri t(.r' fR CGte.A approximately <br /> 11103 feet/mile W of by per fOrin in the following <br /> work: (description of work): �� ,-}-� tl t} ' 4 ' � 51 Z,C4 St" <br /> goad �A, E5 plan -tom Awo_t7 iy+L � " 31�1i='`pas g ice- <br /> !1 nQi ' <br /> Work will commence on or about t —A C 7M n for approximately�_days. <br /> I the undersigned certify that I am the owner of the respective property, or am qualified to represent the <br /> owner agree to do the work described above in accordance with the rules, regulations of San Joaquin <br /> County and subject to inspection and approval. <br /> - e (Y__1-18- r+ <br /> RE OF APPLICANT—TITLE DATE <br />