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//� -w z57 -- <br /> lmf4 ' i c�)69��03 33 p [ C D <br /> MAR 17 2515 <br /> APPLICATION FOR ENCROACHMENT PERMIT <br /> By <br /> PLEASE PRINT: <br /> Date �j��/�S— OFFICE USE ONLY <br /> To: San Joaquin County JOB# Z REF <br /> Department of Public Works APN CR# <br /> EXP.DATE <br /> Z!� VALID 4-2Z 1 S TO/ S_ts'-IS DRIVEWAYS: <br /> (Applicant Name) STREET Skt f{ 2G <br /> /� ✓ AREA (.C((CV1 QUAD F� <br /> 7, TYPE <br /> (Mailing Address) FORMS Sf -W- 47 2Z <br /> NOTES <br /> (City,State,Zip Cade) <br /> (Area Code-Telephone Number) <br /> Sketch(Detailed plans be submitted) <br /> Theand rsigned hereby applies for per issio to exc vate,construct and/or otherwise encroach on County Highway Right-of-Way o <br /> the side of J ori_ approximately ZZ feetto <br /> of by performing the following work(description of work): <br /> i <br /> Work will commence on or about_ 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 /> +gna plicant-Title ate <br /> E4 U35V VlKNVia^T_0.P5L�NCROACHfdEVT P6Ztdfi AAPIJCF.TICW.DOC�O1Nd) <br />