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APPLICATION FOR ENCROACHMENT PERMIT <br /> PLEASE PRINT: <br /> Date e!Sj�Z- /Z0L4 OFFICE USE ONLY <br /> To: San Joaquin County JOB# 7 3 y 5 Z REF# <br /> Department <br /> toof'Public Works 'I APN CR# <br /> f2 l C U !S £ I��G EXP.DATE 3 -( <br /> VALID l`1''( TO3 ?j� DRIVEWAYS: <br /> 1n +n "'01 STREET 1—ON2 Trc e 9 ((;jkg o1 tCy4 4 . <br /> AREA C QUAD <br /> C> <br /> /V rte TYPE <br /> (Mailing Aydress) FORMS <br /> �3 7�6 NOTES <br /> (City,State,Zip Code) <br /> OV <br /> p� Q <br /> (Area Code-Telephone Number) <br /> Sketch(Detailed plans may be submitted)�h <br /> o <br /> Zoe,*2 Jvuelrcc Kd <br /> r X10734 10 <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 /> Work will commence on or about for approximately days. <br /> 1,the unde igned,certify that I am the owner of the respective property,or am qualified to represent the owner and agree to do the <br /> work desc ibed above in accordance with the rules and regulations of San Joaquin County and subject to inspection and approval. <br /> s <br /> E:NUB-SV.WKIMASTERPMI,ICROACHRIENTPERPAITAPPLICATION.DOC(01108) <br />