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APPLICATION FOR ENCROACHMENT PERMIT <br /> PLEASE PRINT: <br /> r <br /> Date . 4 OFFICE USE ONLY <br /> To: San Joaquin County JOB# 7*V93 REF# <br /> Department of Public Works APN _ CR# <br /> EXP.DATE <br /> VALID ! T /y �' DRIVEWAYS: <br /> (Applicant Name) STREET �,,;,��:�, AAAW, <br /> AREA QUAD <br /> TYPE fj2/N /��aty A7c �io fol <br /> (Mailing Address) FORMS <br /> NOTES <br /> kff)n, ca. qmo <br /> (City,State,Zip Code) <br /> (Area Code-Telephone Number) <br /> Sketch (Detailed plans may be submitted) <br /> 6&21 <br /> The undersigned hereby applies for permission to excavate, construct and/or otherwise encroach on County HighwRight-of-Way on <br /> of _side of _ 1CGt15 approximately s? eeY ile <br /> by performing the following work( scription of work): <br /> 1 0 <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 /> z ��y, /tee,/�. <br /> 4n1of Applicant-Title Date <br /> E:IPUB-SV.WRIMASTER PSIENCROACH MEI IT PERMIT A PPL I CATION DOC (01108) <br />