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IVO I IV 1 <br /> APPLICATION FOR ENCROACHMENT PERMIT <br /> PLEASE PRINT: <br /> Date /C// <br /> 1"goJ0 OFFICE USE ONLY <br /> To: San Joaquin County JOB# 7A WQ–A REF# <br /> Department of Public Works APN CR# <br /> EXP.DATE -1 . 0)0 <br /> �l VALID — - 70TO + +,.qLblb DRIVEWAYS: <br /> ( licant Name) STREET L fAlat,0,0 kj, <br /> AREA — QUAD <br /> TYPE fla ze <br /> (Mai dress) FORMS .7 <br /> NOTES <br /> (City, tate,Zip Code) <br /> (Area Code-Telep one Number) <br /> Sketch(Detailed plans be submitted) <br /> 09 <br /> The undersign hereby applies for er iss' to excavate, a s ct and/or otherwise encroac n County Highway Ri ht-of-Way on <br /> the S side f_ approximately fee i e r�D/ <br /> of by performing the follo ing work descnptio of work): <br /> l <br /> Work will commence on or about 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 accord ce with the rules and regulations of San Joaquin County and subject to inspection and approval. <br /> Srgnapfe of Applican - rtle s � <br /> 3A <br /> Dat <br /> (01%) <br />