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APPLICATION FOR ENCROACHMENT PERMIT <br /> PLEASE PRINT: <br /> Date OFFICE USE ONLY <br /> To: San Joaquin County JOB# 2 REF# <br /> Department of Public Works APN CR# <br /> EXP.DATE 0.7, 9 <br /> V P.L VALID TO DRIVEWAYS: <br /> (Applicant Name) STREET A5?,vA L> <br /> AREA -el,'PeAl QUAD <br /> TYPE <br /> (Mailing Address) FORMS <br /> NOTES <br /> (City,State,Zip Code) <br /> (Area Code-Telephone Number) <br /> Sketch(Detailed plans may be submitted) <br /> Z. L <br /> 7 I Lj r Ll <br /> The undersigned hereby applies forpermission to excavate,construct and/or otherwise encroach on County Highwa Right-of-Way on <br /> tlhe.-aa 1 side of f r'�L-- approximately_1 6 e mile <br /> EF by the follow e <br /> of tE y pfollowing work( escdption of work): <br /> '.L'0 f J nq I /J 0 <br /> fA)hlrH ttt F ri U i �t"\LL kl ';' t <br /> Work will commence on or about 7n(-)c*< for approximately &SC> days. <br /> 1,the undersigned,certify that I am the owner of the respective 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 /> Signature of Applicant-Title Date <br />