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' ��.�2i .�v✓�iU L�?zS> 5�-mss" �/� <br /> APPLICATION FOR ENCROACHMENT PERMIT <br /> PLEASE PRINK`: <br /> Date �'��� t>j � OFFICE USE ONLY <br /> To: San Joaquin County JOB# �(� REF.# <br /> Department of Public Works APN �� — <br /> CR# <br /> EXP.DATE <br /> /�' //'��r��� - ���C�/l'��✓�'�/,/LsC�- VALID <br /> (Applicant Dame) STREET .� 2S 2c A:5 TO DRIVEWAYS: <br /> AREA St QUAD 1'w. <br /> , fir TYPE . ----r <br /> (Mailing Address) FORMS <br /> f L�� ' NOTES <br /> (City,State,Zip Code) — —— <br /> (Area 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 Highwa Right-of-Way <br /> the `ISTS��� side of �cii tYY on <br /> of f`' � ���,�/yG' � vt�., /r���>y '� approximately 0 ' mile <br /> by performing the following work d-escription of work): <br /> — 1a /rte <br /> Work will commence on or about <br /> 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- <br /> work described above in accordance with the rules and regulations of San Joaquin County and subject to inspection and approval. <br /> Signature of Applicant o Tale <br /> Date <br /> M:1CEMRALSETMCE=LEZICAll?oasv.wf-MSTERpSMCROACHklEWTPSR&IrTAppLjCAT1oNDOC(09,13) <br /> 1 <br />