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APPLICATION FOR ENCROACHMENT PERMIT <br /> PLEASE PRINT: <br /> Date (a ��� OFFICE USE ONLY <br /> To: San Joaquin County JOB# T42�CCX,52 6 REF# <br /> Department of Public Works APN CR# <br /> EXP.DATE <br /> VALID 1 _ TO � DRIVEWAYS: <br /> (Applicant Name) STREET <br /> AREA QUAD r—.-- <br /> TYPE TYPE i <br /> (Mailing Address) FORMS <br /> NOTES <br /> (City,State,Zip Code) <br /> 7e 7 <br /> (Area Code-Telephone Number) <br /> Sketch(Detailed plans may be submitted) Lvti r?v r-i C. <br /> The unrsigned hereby applies fqr permission to excavate,construct and/or otherwise encroach on County Highway Right-of-Way on <br /> the—�7 s t- side of /Vu rf-k t' I-rpt°� approximately_ �r(� ee mile , 6-A-t-\ <br /> of 9 fiQ; by performing the following work(description of work): <br /> T � <br /> 4 V- r \�,etlh ,le <br /> Work will commence on or about -1- for approximately , days. <br /> I,the undersi ,c fy that I am the owner of the respective property,or am qualified to represent the owner and agree to do the <br /> work des�ri ed a vein accordance with the rules and regulations of San Joaquin County and subject to inspection and approval. <br /> e✓w+r F �� <br /> _Signature of pplicant-Title Date <br /> I <br /> M:ICENTRALSERIACESICLERICALIPUB-SV.WKIMASTER.PSIENCROACHMENTPERMRAPPLICATION.DOC(09m) <br />