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APPLICATION FOR ENCROACHMENT PERMIT <br />PLEASE PRINT: <br />Date d./aq I,c, <br />To:San Joaquin County <br />Department of Public Works <br />:I{'rl~«\1\~'eAt'a rJ Con~i;.(Appli nt Name).• <br />F?D.j?~0',(1.41~,' <br />(Mailing Address) <br />~tkrsO'{\lA\'{q5~b3 <br />(City.State,Zip Code) <br />'clDQ-9V3-9/(,4(Area Code.Telephone Number) <br />Sketch (Detailed pians may be submitted) <br />See.a~hout S\<e-'\-~~ <br />OFFICE USE ONLY <br />JOB#Ii (JOO >'REF# <br />APN CR# <br />EXP.DATE 6--(~/' <br />VALID 4-7-/6 TO fr(-Ib DRIVEWAYS: <br />STREET Durham Ferr,v ~OI • <br />AREA la.•'Y QUAD 5W • <br />TYPE /.• <br />FORMS <br />- <br />NOTES <br />Work will commence on or about -,q.'--I-l-,-'J~I•...iL.-7bo«-for approximately /day days. <br />I,the undersigned,certify that I am the owner of the respective property,or am qualified to represen'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 />~fuPMK'Signature of Applicant.Title <br />E:\OUB-SV.WKlMASTERPSlENCROACHMENT PERMITAPPUCATION.DOC (01/08) <br />?;,/d..C1 II b <br />Date