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APPLICATION FOR ENCROACHMENT PERMiT <br />PLEASE PRINT: <br />Date ~dO.;).Q /WI <br />To:San Joaquin County <br />Department of Public Works <br />CAuf:.()I2JOIA vi ATEl?.txtiUj )~E <br />.(Applicant Name) <br />lloaa.E t--AFAV EITE ST <br />(Mailing Aojdress) <br />-,sTOCIL.ibN 01 qSC)DS <br />(City,State,Zip Code)'~q~if Lo LJ -~31 I .~(Area Code.relephone !\lumber) <br />Sketch (Detailed plans may be submitted) <br />:~~3OFFICEUSEONLY <br />JOB#7iOO22 REF# <br />APN CR# <br />EXP.DATE ~._,-'~. <br />DRIVEWAYS:VALID _.::~~=TO !~:1-'6 •STREEI L14r;'"~Cq :II . <br />AREA S¥oc.-(+0.:(1 QUAD 5 G-• <br />TYPE 11«''1 (11 • <br />FORMS SSVV'(J..:z.orNOTES-.-..... <br />:1.- <br />;).:x <br />The undersigned hereby applies for permission to excavate,construct andlor otherwise encroachon County Highway Right-of-Way on <br />the_~sideof .approximateIY_~feetlmile _ <br />of .by performing the followingwork (description of worl(): <br />Wont will commence on or aboul fTr approXj'ately days,Q/i5'J!itJI,the undersigned,certify that I am the owner oHhe respective properly,ora ualiiied to.presentlhe 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 />M.:\CEN1lW5ER\1lCES1ClB'lICAlIfUB-SV.WKlI.IASIERFslENCROACIlMEUT PERMIT APPuCA1JON.OOC (O~1SJ