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APPLICATION FOR ENCROACHMENT PERMIT <br /> PLEASE PRINT: <br /> Date .. ----- --- ------------ --- - -- <br /> OFFICE USE- ONLY <br /> To: San Joaquin County JOB# REF# {� <br /> Department of Public Works APN CR# <br /> i - EXP. DATE 7.2Sa4 <br /> VALID 7 23 a TO _ Zs�-7 DRIVEWAYS: <br /> STREET <br /> (Applic t Name -- <br /> ��ie,ehrsai�/ <br /> ' AREA � _ <br /> l - _ --- _ - <br /> Nut , <br /> Irl QUAD , <br /> a r rT�r - TYPE <br /> (Mailing Address) FORMS <br /> NOTES <br /> (City, State,Zip Code) <br /> 3 'E i <br /> Area Code-Telephone Number) <br /> Sketch (Detailed plans may be submitted) — - - --- <br /> I <br /> N. <br /> i <br /> i <br /> i <br /> i <br /> i <br /> The undersigned hereby applies for permission to excavate, construct and/or otherwise encroach on County Highway Right-of-Way on <br /> I`1e i, ,-- -} side of . l - K� _ _- <br /> ximately <br /> of )n#'e _- — =--------- — aPPr by performing.t e following work(`ee mile <br /> ascription of work): <br /> i�� �• <br /> (yin �c►rvN Q, L.,� <br /> "11764, <br /> 91W ����ti--•�'-��=---�=-��_}�-e-t��tPv�t L� 3 !>�?r1 t�'v.. <br /> Work will commence on or about___ - <br /> for approximate y - / days. <br /> I, 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 ' -------- -- --- - _____ — <br /> Date �- ---- <br /> .. . . k P„'t Nei. i ;app',!I i iu m-ri u;n!(M U:iC 0110e <br />