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APPLICATION FOR ENCROACHMENT PERMIT <br />PLEASE PRINT: <br />Date 10 1£,(t, ( t<o <br />To: San Joaquin County <br />Department of Public Works <br />K/\l If£ 1<1 vffic. Cy,JsL&�e fYci>e;A0 <br />(Applicant Name) <br /><t6S v-1-CL.A'-{ 5t-. <br />(Mailing Address) <br />5wO<tvN t CA 152a'o (City, State, Zip Code) <br />ezo� Cf46-030Z <br />(Area Code . Telephone Number) <br />JOB# APN EXP.DATE VALID STREET AREA TYPE FORMS NOTES <br />OFFICE USE ONLY <br />PS -((.pO 3l-lLt Z.. REF# CR# 14/ �17/-:f. \lJ1J.1!i' TO \/1il1(r DRIVEWAYS: <br />t,V o. wf'Y'A Avi/ Airbwf �, ·QUAD I *.* <br />Sketch (Detailed plans may be submitted) >cE A�)-71.-.�c..i: �Arflc CovTiwL, 5rGN5 \�,1'-h""4 5� joAQ(.)"N '?tc-,fn OF \JA>-<,{t-.1.CLv\)I� �-rD.J'2.. ?civ"Tt, <br />The undersigned hereby applies for permission to excavate, construct and/or otherwise encroach on County Highway Right-of-Way on <br />the side of sa A:,nt\c,m:..""') approximately feet/mile ---of , y performing the following work (description of work): 7 w rN -S-�C\). fZ.o. \J. � USc ro'D R. otlt:. Zr>-'C.. ol'-I WO()OW� A-yf;"� 5€e ,ATi7Jc,/h:)_ <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 work described above in accordance with the rules and regulations of San Joaquin County and subject to inspection and approval. Z -?R-o.<itcr rYlGt 10 lz,r, Jw � date <br />f.\PUB.SV.WKIMASTERPS1ENCROACHMENT PfRlllT APPllCATION.DOC (01.llB)