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-316 1 Zo S�Z <br /> APPLICATION FOR ENCROACHMENT PERMIT <br /> PLEASE PRINT: <br /> Date 6 G�lj's— OFFICE USE ONLY <br /> To: San Joaquin County JOB# -7 300 S REF# <br /> Department of Public Works APN CR# <br /> 1� n /" / EXP.DATE <br /> I G t, "� CTG J /LL�v� C VALID 7-2-1,4 TO DRIVEWAYS: <br /> (Applicant Name) STREET80192 <br /> AREA � QUAD <br /> �Ii-i-ITYPE <br /> (Mailing Address) FORMS <br /> NOTES <br /> ('r� �, sz Jul <br /> (City,State,Zip Code) <br /> 7(p7 <br /> (Area Code-Telephone Number) <br /> Sketch (Detailed plans may be submitted) <br /> The and rsigned hereby applies for permission to excavate,construct and/or otherwise encroach on County Highway Right-of-Way on <br /> the � '2'Lty - side of 41 >ti �,r � approximately Aol t� e�f eNmile kJOS <br /> of 1 , by performin the following work(description of work): <br /> Work will commence on or about y Z-I S for approximately [r,U days. <br /> I, the undersigned ' that I am the owner of the respective property,or am qualified to represent the owner and agree to do the <br /> work descri above i accordance with the rules and regulations of San Joaquin County and subject to inspection and approval. <br /> PC i 06&5h/-� <br /> � Fb of Applicant-Title Date <br /> M ICENTRALSERVICESICLERICALIPU&SV.WKIMASTER.PMENCROACHMENT PERMIT APPLICATION DOC (09113) <br />