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209 9527381 8-mile enginerring 08:55:57 a.m. 08-19-2009 2/2 <br /> APPLICATION FOR ENCROACHMENT PERMIT <br /> PLEASE PRINT: <br /> Date OFFICE USE ONLY <br /> To: San Joaquin County JOB# REF# <br /> Department of Public Works APN CR# <br /> EXP.DATE - <br /> f•� f 1 VALID .d TO �.6 DRIVEWAYS: <br /> (Applicant Name) STREET <br /> AREA f/ QUAD_ <br /> ALJ - <br /> (Ma <br /> �Address�) � TYPE <br /> FORMS <br /> � NOTES -- <br /> (City,State,7_ip Code)L�r. L v - <br /> " LLL c� <br /> (Area Code-Telephone Number) - ---- <br /> Sketch(Detailed plans may be submitted) - <br /> t <br /> 4 <br /> 1 <br /> I <br /> 1 <br /> The undersigned hereby applies for permission to excavate,construct and/or otherwise encroach on County High Right-of-Way on <br /> the&&t A&)E:q side of <br /> of_[pec.- C.Lha ----ra ( TI __approximately feet/ ileQQ <br /> by performing the following work(description of work): <br /> -�IzC <br /> �Z -- <br /> 0 n <br /> Work will commence on or about._ <br /> or approximately <br /> _ day . <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 /> _4S <br /> Signatur pplicant••Title __Sj'a <br /> gate <br /> e v��sv wKunesrax.rrxxonc,usra r+aµi.wwiearrorvnw ia,roe� <br />