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?VA 3113 iL6,0 <br /> APPLICATION FOR ENCROACHMENT PERMIT <br /> PLEASE PRINT: <br /> Date gh S OFFICE USE ONLY <br /> To: San Joaquin County JOB# 7 3d 0S1 REF# <br /> Department of Public Works APN CR# <br /> EXP.DATE t -I T <br /> G VALID Jq 7-1 S_ TO DRIVEWAYS: <br /> (Applicant Dame) STREET <br /> l J AREA,,,, UAD <br /> `� �y Cfi G/�l� TYPE <br /> (Mailing Address) FORMSR7 Cr <br /> NOTES <br /> < cp , 9S26-' <br /> (City,State,Zip Code) <br /> ZAA- - 3/G- 17(o-7 <br /> (Area Code-Telephone I _umber) <br /> Sketch (Detailed plans may be submitted) <br /> fJ-TTk+t- <br /> / <br /> The undersigned hereby applies for permission to excavate,construct and/or otherwise encroach on County Highway Right-of-�lla on <br /> the 5 c �A-L— side of �vG ce �j' approximately IZ�S` — ftmile �V11 <br /> of 1MciL,k c C by performing the following work(description of work): <br /> Work will commence on or about -7—1 -1 S" for approximately days. <br /> I,the un c.il ne that I am the owner of the respective property,or am qualified to represent the owner and agree to do the <br /> work descri abo in accordance with the rules and regulations of San Joaquin County and subject to inspection and approval. <br /> P�" t 6,Zu/l <br /> e of Applicant-Title ®ate <br /> M:ICENTRALSERVICESICLERICALIPUB-SV.WKIMASTER.PSIENCROACHMENTPERMITAPPLICATION.00C (09113) <br />