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APPLICATION FOR ENCROACHMENT PERMff <br /> PLEASE PRINT: <br /> Date A Nr- OFFICE USE ONLY <br /> To: San Joaquin County JOB# 73wsz-4=, REF# <br /> Department of Public Works APN CR# <br /> & <br /> EXP.DATE I- <br /> VALID 0 TO DRIVEWAYS: <br /> (Applicant Name) STREET )eb, <br /> AREA QUAD <br /> TYPE <br /> (Mailing Address) FORMS <br /> NOTES <br /> (CstY,State,Zip Code) <br /> (,_771 7 7 <br /> (Area Code-Telephone'Number) <br /> Sketch(Detailed plans may be submitted) <br /> ;4-T 7 4 Cif F"6 -elrM Gf <br /> 1 -7 q� <br /> A CA� 1P>51 &r*95 <br /> The undersigned hereby applies jor permission to excavate,construct and/or otherwise encroach on County Highway Right-of-Way on <br /> the_&d k -side of.. e - <br /> of LN w4q� approximately_.. <br /> it — by performing the following work(description of work): <br /> .5-C eu Pk'a <br /> Worl<wiil commence on or about 2 for approximately qy <br /> days. <br /> 1, the undersigned,cern 5 am the owner of the respective property,or am qualified to represent the owner and agree to do the <br /> work describe v!ein =rdance with the rules and regulations Of San Joaquin County and subject to inspection and approval. <br /> ignature of Applicant-Title <br /> " bate <br /> PSIEt4CRCACHIVENTFERMFFAPPLiCATTO[4 DOC (W113) <br />