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1 < <br /> APPLICATION FOR ENCROACHMENT PERMIT <br /> PLEASE PRINT: <br /> Date �,� ( �} G OFFICE USE ONLY <br /> To: San Joaquin County JOB# REF# <br /> Department of Public Works APN CR# <br /> EXP.DATE _ f0 <br /> VALID TO DRIVEWAYS: <br /> (ApplicantName) STREET , <br /> AREA QUAD <br /> 333 CAU l t. z �s � �12 Z,4- TYPE <br /> (Mailing Address) FORMS <br /> NOTES <br /> T'(City,State,Zip Code) <br /> (Area Code-Telephone Number) <br /> Sketch(Detailed plans may be submitted) <br /> k., 6 <br /> The undersigned hereby applies for permission to excavate, construct and/or otherwise encroach on County Highway Right-of-Way on <br /> the kk S side of approximately/35 feedr le <br /> of q } on of work): <br /> yy y performin the followpping work (f(description ti <br /> ( 4 t <br /> is —;1 � <br /> Y <br /> w <br /> r <br /> T i <br /> M Work will commence on or about .0 for approximately _,.,� 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 /> - bqIr-:7 <br /> Signature of Applicant-Title .� > Date <br /> 1APUB SV.WNVAASTER.PSIENCROACHMENT PERMIT AFPEICATION.DOC (011081 <br />