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APPLICATION FOR ENCROACHMENT PERMIT <br /> PLEASE PRINT: <br /> Date O L{ - 2-2.- 15 OFFICE USE ONLY <br /> To: San Joaquin County JOB# zl0006- REF# <br /> Department of Public Works APN CR# <br /> EXP.DATE <br /> L.mden AAihl-C-hG 6005terS VALID lco ry TO fes ' DRIVEWAYS: <br /> (Applicant Name) STREET 1201.05 <br /> AREA 1,/N,06A1 QUAD A r- R <br /> 4 lq S G P�LL.OVVA,`i C7 TYPE 5k lew-- 7—l2A6'FIC ez"n&c" >c <br /> (Mailing Address) FORMS r <br /> NOTES <br /> S 19C-Y-TON, C A q 5215 oA.7> 6 su/96s <br /> (City,State,Zip Code) <br /> ����vA ✓IAyi� 2.ots' �� <br /> 2001 - 40b - Esq 1 :�� ,r✓1 Td :�s <br /> (Area Code-Telephone Number) <br /> Sketch(Detailed plans may be submitted) <br /> See rn c--p cE l a C hed <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 /> 0Ltr run boo.i r)J v e IInde-n c . t�oC-ee . uw ; <br /> cz I - o rt I ID , re&i oo <br /> onto CJ oi- a ' u r °1 C-0 k , <br /> f. <br /> b <br /> Wo will commence on or about M AY 1 b, Z O t 5 ! 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 describe in accordance with the rules and regulations of San Jgaquin County and subject to inspection and approval. <br /> Signatu pplicant-Title Date <br /> Y: was R MWLATEMCROACNEEM PEwaRAPPUMT10Ndx(0808) I' <br /> f <br />