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P11Ay 7 2 5 <br />APPLICATION FOR ENCROACHMENT PERMIT <br />ByPLEASEPRINT: <br />Date h 5— OFFICE USE ONLY <br />To: San Joaquin County FJO 7 REF <br />Department of Public Warks CR# <br />4 5 L EXP.DATE 7 /S - 1S <br />Applicant Name) <br />VALIDTO IS DRIVEWAYS: <br />ET <br />i*il/P//4, / 45 <br />AREA QUAD <br />TYPE <br />Mailing Address) FORMS S5727 <br />NOTES <br />State,Zip Code) <br />5ry7 sZ <br />Area'Code-Telephone Number) <br />Sketch(Detailed plan may be submitted) <br />The undersigned hereby applies for permission to excavate,construct and/or otherwise encroach on County Highwa Right-of-Way ontheQs- side of S_ih,u/ ,fi r/ approximately ZOO ee mile SLf_LofLtir 6QQ by performing the following work(description of work): <br />noc-zcef <br />Work will commence on or aboutfor approximately da s.y <br />I,the undersigned,certify that I am the owner ofthe respective property,or am qualified to represent the owner and agree to do theworkdescribedaboveinaccordancewiththerulesandregulationsofSanJoaquinCountyandsubjecttoinspectionandapproval. <br />AS—Si ure ofApplicant-Title Dat <br />eJ}i715+'d.l/5"EF.P:"Ei,C?":HMU7 -?W7iIt-,J_ CpC;o,A;)