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r <br /> o rrore: <br /> To:12094682999,5013# Pa9e:1/3 <br /> APPLICATION FOR ENCROACHMENT PERMIT v <br /> PLEASE_PRINT: <br /> Date ;7 <br /> OFFICE USE ONLY <br /> To- San Joaquin County JOB# <br /> Department of Public Works REF# <br /> AAN CR# <br /> 1✓G�' j ,. Q / EXP.DATE `7 <br /> (Applicant Narne) VALIDAREA <br /> — T O •i .,0`� DRIVEWAYS: <br /> �/ Z z 2y AREA QUAD - <br /> (Mailing Address) TYPE FORMS ' <br /> NOTES <br /> J (City,State,lap Code) <br /> 373 <br /> (Area Code-Telephone Number) <br /> Sketch(Detailed plans may be submitted) <br /> ?- ,1a �u,2pyo /v/a 2411, <br /> The undersigned hereby applies for permission to excavate, construct and/or otherwise encroach on County Highway Right-of-Way on <br /> the side of____, <br /> of approximately feel/mile_ <br /> by performing the following work(description ofow rk): <br /> Work wH!commence on or about - <br /> for approximately <br /> f, the undersigned,certify that f am the owner of the respective property, days. <br /> work described above in accordance with the rules and regulations of San Joaquin County andto subject to iesent the �er and agree to do the <br /> '� �of <br /> spection and approval_Signature Applicant-Title <br /> 171 <br /> Date <br /> L*%*Sv.WRQMautvSU'UM%OWVM i"AMUC,%Io CC pUt9� <br />