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APP ICAVON FOR ENCROACHMENT PENH <br /> PLEE PE PRGNT. <br /> Plate _$ � �� <br /> or-F(cE USE ONLY <br /> To: San Joaquin County JOB# ,oe- _ REF 4 <br /> Department of Public Works APN <br /> L cR <br /> L EXP.DATE <br /> G ;. <br /> ti�� nM 2 l 1 7 vAL(® t{r,• �,} <br /> (AppGucau� �e9aru�e 'TO / /_5- DRIVEWAYS: <br /> STREET ?.� r py 111'g—, <br /> ARPA 5 kC4 QUAD <br /> E �5 <br /> (Niailing Address) FORMS <br /> GJW L9 r��Gd <br /> NOTES <br /> (city,aatO,fop Code) — <br /> 381-1?Z -7 6xv! e&-dE�e�o�,v <br /> (Arca Ccde-TetepP UmbG\iUmbar) <br /> Sketch(Detailed plans may be submitted) <br /> The undersigned hereby applies for permission to e):cavate,co�struct and/or otherwise encroach on County Nighwa Right-of-Wa on <br /> the side of G�I S rva� approximately <br /> of � o r A r-v- A v ee ile_ <br /> 2 , by performing the following work escription of work): <br /> for approximately days. <br /> I, fihe undersigned,certify that I am the owner of the respeciive 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 /> Sugnaftire of AppGucant o TNo — — 17 <br /> M1110EtlIFJiLSERVICESICLERICAUPUaSV-4%'KL,if,STER.PSIQICROACHh%EfITPEfU,4ThPPLICATIQIIDOC (OV13) <br />