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APPLICATION FOR ENCROACHMENT PERMIT <br /> PLEASE <br /> Date OFFICE USE ONLY <br /> To: San Joaquin County JOB REF <br /> Department of Public Works <br /> VALID AIM- I DRIVEWAYS: <br /> (Applicant Name) STREET WzoAZ-�—W AK. <br /> AREA 5M6kTG4 QUAD A145 <br /> (Mailing Address) FORMS le-2-1 <br /> NOTES <br /> (City, State,Zip Code) <br /> (Area Code-Telephone Number) <br /> Sketch (Detailed plans may be submitted) <br /> The undersigned hSrehvopp|ies for permission toexcavate,construct and/or otherwise encroach onCounty High Right-of-Way <br /> of �Z476-ir-CO(-; ';zb -, 2S 1-0 by performing the following work(description of work): <br /> Work will commence on or a Dout 10 1 r <br /> for approximately... 3co days. <br /> |'the undersigned,ceddythot|amthoownorofthemopooUvopmpedy. oromqua|ifiedk)mpnmentdlomwnerandagnmhodoUho <br /> work described above in accordance with the rules and regulations of San Joaquin County and subject tuinspection and approval. <br /> �� <br /> S�i�e kdf Applicant-Title Date <br /> MIC17NTP,ALSERVICE'.�CLERICALPUP,SV'.VKNIASTERPSE'ICROACHMENTPERk"ITAPPLGATION DOC (09113) <br />