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APPLICATION FOR ENCROACHMENT PERMIT <br /> PLEASE PRINT: <br /> Date 05-06-60i_5 OFFICE USE ONLY <br /> To: San Joaquin County JOB# '7�r �'� r � REF# <br /> Department of Public Works APN CR# <br /> (zem I T- T'o: PE2m i r OC:SrC 0 Zto�917�Jh tT,c DATE <br /> —7-1S , IS <br /> Ar'4 r/SHE-R.2y PA*-y-5 (PER-0%rT DC-S4) VALID 7-/S-is TO DRIVEWAYS: <br /> (Applicant Name) STREET <br /> AREA —QG t QUAD <br /> 5555 1-. QLA,gI- AVE TYPE <br /> (Mailing Address) FORMS 51 J4/lA/ P? <br /> -7 <br /> NOTES <br /> {-(�.-esf- q0 GA � --7Z I7 <br /> (City,State,Zip Code) <br /> (-55+ y5 4- L4900 <br /> (Area Code-Telephone Number) <br /> Sketch(Detailed plans may be submitted) <br /> P <br /> LC--A-5G 1Z E F-C,2 -rte ;4T T A C H Gvj O,Z A-tv i rvG. <br /> j�fz0 SE--cT c#- A-CXD 5 J D C) - 3 A L'L To i3 <br /> iqa C - V O K DC-tr Qd<6 <br /> Fac- SG <br /> UG Zq- L-0 <br /> A r r r - M I KE me-CA-aUC- / <br /> Z 3Cx> G. C-+G-t t-r• r, ,4 2 C� <br /> 5-Tr-3CtcTnr0, c_A- q 5 21 O <br /> (ZO`?) 474-47-7q <br /> The undersigned hereby applies for permission to excavate,construct and/or otherwise encroach on County High�way Right-of-Way on <br /> the CJC--S i side of N• ALP /sV e 12-ID approximately [7 elt ile <br /> of Z- '--I-P G-G Gu r..1OU IT. _, by performing the following work(description of work): <br /> Q;2Ec_ n�hllft, r'30(Le f'f2O^1 'r"- 2CPER-T`/ /-5G51 n1, A-L p,+tiE /ZO <br /> TZ) .JO+ +,.1 T PC Lie A-C Z-G S S r-2 _ —T / pi2c>rC,�rw-rC.�1 50 Pc&C C- z - 1 " <br /> CcirjoU i T rz� plzov +(p1- 'TerzvI <br /> Work will commence on or about for approximately 5 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 descnbed above in accordance with the rules and regulations of San Joaquin County and subject to inspection and approval. <br /> Signatu of Applicant•Title Date <br /> n 2er'i nod C.4 rn ►-i , 5l-Y'U-ho Y <br /> UCEMPaISE➢ViCESCIEFKALWI&SV W1tuaSTEA VSlEnt'PGKWAENT PEa�{pp_{GAiIGN GGC ig!13) <br />