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f`j �'y �\ ��•. � l '� f' �� �J......J�� ..,..t.� /tj!/� f;11 ll <br /> APPLICATION FOR ENCROACHMENT PERMIT - <br /> PLEASE PRINT: <br /> Date !0 - L OFFICE USE ONLY <br /> To: San Joaquin County JOB# � '�2 REF# <br /> Department of Public Works APN CR# <br /> w EXP.DATE: <br /> ~ =' = _ _ - <br /> VALID TO DRIVEWAYS: <br /> (Applicant Name) STREET ' <br /> QUADTYPE - lye <br /> TYPE <br /> (Mailing Address) FORMS (2 <br /> � NOTES <br /> �- 9 ``��� <br /> (City,State,Zip Code) <br /> (Area Code-Telephone Number) <br /> Sketch(Detailed plans may be submitted) <br /> The undersigned hereby applies for permission to excavate, construct and/or otherwise encroach ori County Highway Right-of-Way on , <br /> the Uf side of 5 . MACA PTHL0)F, P?-- approximately '500 feet/mile �4 o <br /> of_ `O-=I-0 6 , MA C'Ar 9"'i`�+l l�-' ?— —_,by performing the following work(description of work): <br /> fis t I <br /> Ca Or-) DeTf Mko 7F-5j <br /> Work will commence on or about —for approximately days. <br /> I,the undersigned,certify that J am the owner of the respective property,or am qualified to represent the owner and agree to do the <br /> work describedipbove in acccs darlce with the rules and regulations of San Joaquin County and subject to inspection and approval. <br /> Si n tura of Applicant-Title Date <br /> E:'PU8SY.V&IMAS?Ei.?SENCROACHMENTPcWrTAPPUCATIONDOC(01=1 <br />