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APPLICATION FOR ENCROACHMENT PERMIT <br /> PLEASE PRINT: <br /> Date ��" 2i�" S OFFICE USE ONLY <br /> To: San Joaquin County JOB# REF# <br /> Department of Public Works APN CR# <br /> n EXP.DATE <br /> �t M 66'o rO U/L o F QkL-i FO+2.1'Ih VALID //- i S TO 6-11-15r DRIVEWAYS: <br /> (Applicant Name) STREET Ee4ro.TRt, JAHRAX-oer-•,6,k06 4 5Ac• <br /> AREA Alo z H C rY QUAD AIS <br /> V3 ffCem Pn N A V& TYPE 5{'ku-►Rt_ ✓ !r <br /> (Mailing Address) FORMS <br /> NOTES <br /> M09t:7 i PAAk c 9/ 53 -A� Al riuk zvr Amy <br /> (City,State,Zip Code) r Al 2:acv /m -/o 3: Sty <br /> &Xo- 6qs--S.ss1 <br /> (Area Code-Telephone Number) <br /> Sketch(Detailed plans may be submitted) <br /> be7TA•ie_E_b -PLANS Amt✓ ATAMa-h <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 /> CAP h7A#jPr69,,o Ao&&ING O e-�L^F OF -rhC FOLD-O W iN R-0.4D5= CLAy 5-rmn o a., <br /> -J Pr**A r An.e ZZw6X, !GAO AAy"Enrb ro t_oA, errs 14.a.rs -MTAs-limo ens <br /> C'OV0TJ JU*05 /s 3s-l"lAorer -rUrftt- Di6r4&0Z Is <br /> Ne CooTV R&SvuAtes A96 QwXEO <br /> Work will commence on or abouts rl.a0� S 4:11 pm 4a 3:aogw% for approximately 35'Mi NdTgs A.- <br /> 1,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 /> Sign r f Applicant-Title Date <br /> MiCB/iMLgRVICES.CIBtILAL1FUBSU.�IENTPFAYTNRIGTN7N.000 JM3) <br />