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APPLICATION FOR ENCROACHMENT PERMIT <br /> RECEIVED <br /> PLEASE PRINT: <br /> 2006 APR 12 AM 14: 49 <br /> Date -c�p 'b`G <br /> OFFIC5E7'E791" v9,N T,(FSL,IC `,y 0R t S <br /> To: San Joaquin County JOB # REF ## <br /> Department of Public Works APN CR' # <br /> EXP. DAT <br /> � /S deo <br /> u VALID 'f I? TO mh5-laco DRIVEWAYS: <br /> (Applicant Name) STREET <br /> �fo4O QST GN•// AREA QUAD <br /> TYPE _�_ �� O @ � 111r <br /> TYPE <br /> G <br /> (Mailing Address) FORMS e.Z9 <br /> �(�� � � �• 1 Z� <br /> NOTE- <br /> (City, <br /> OTE`(City, State, Zip Code) <br /> (Area Code - Telephone Number) <br /> Sketch (Detailed plans may be submitted) <br /> p ►o'Z <br /> The undersigned hereby applies for permission to excavate, cc struct and/or <br /> other 'se encroach n County Highway Right-of-Way on the 0+41 side of <br /> approximately feet/WiAt ,als+ <br /> of by performing the <br /> following p '(, <br /> work (description of wor ) <br /> -� l��v{i�Gy� <br /> � V -1� <br /> Work will commence on or about -o for approximately <br /> days. <br /> I, the undersigned certify that I am the owner of the respective property, or am <br /> qualified to represent the owner and agree to do the work described above in <br /> accordance with the rules, regulations of San Joaquin County and subject to <br /> inspection and approval. <br /> t-P <br /> e�ofApplicant - Title ��� Q♦ Date <br /> CHDL (6/00) -'-'�•"� ��� V 1O� <br /> `p8 PROCESWM DESK- BLD 1 <br /> � <br /> 4040'Wed Lm" <br /> Q <br /> . S T OCKM CA 9504 <br />