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APPLICATION FOR ENCROACHMENT PERMIT <br /> PLEASE PRINT• <br /> Date �' ��nlp OFFICE USE ONLY <br /> To: San Joaquin County JOB # REF # <br /> Department of Public Works APN CR # <br /> EXP. DATE <br /> VALID T DRIVEWAYS: <br /> (Applicant Name) <br /> � STREET <br /> �`lt!"►� � ) l ,J AREA QUAD <br /> TYPE <br /> (Mailing Address) FORMS __ GcJLlI, -29 <br /> I� 04 NOTE' <br /> (City, State, Zip Code) <br /> (Area Code - Telephone Number) <br /> Sketch (Detailed plans may be submitted) G <br /> rn <br /> N <br /> a� �p <br /> o 1014 �. <br /> The undersigned hereby applies for permission to excavate, co truct and/or <br /> othhe 'se er reach on County Highway Right-of-Way on the side of <br /> T- 10 approximately _ ,feet/mgt:i <br /> of -- U&� LA LD�. � .. by performing the <br /> ollcw- g work description of work) : 2 <br /> Work will <br /> � commence on or about for approximately <br /> fl�.-- 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 /> 61&, '6trahr 4 -11-06 <br /> rature Applidant - Title /���w■�� Date <br /> (6/00) RE•U�A���FI��� <br /> P <br /> JOBEISDESK- BLD 1 <br /> 4040'� �/ %W <br /> S VCKMN, CA 95W4 �� <br />