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t <br /> APPLICATION FOR ENCROACHMENTT PE <br /> WEIVED <br /> PLEASE PRINT: P. .OAOUIN OOUNZ <br /> Date 7 " D6FFICE 'USE ONTLY <br /> DEP <br /> 7, <br /> 72 T.. OF PUBLIC.WOR.KS <br /> To: San Joaquin County JOB fr 73,05?_(o REF ' <br /> Department of Public Works AP-N CR. rt <br /> fl n, tXP. DATE <br /> /"/rIG�//C/C S L�LL�GTK/C �. VALID !? 410a TO _f D/-O rT DRIVEWAYS: <br /> (Applicant Name) STREET6-1e-M7-"1e6 ,hD <br /> y0 5�D G.�ES% AREA :>-rxA/ QUAD NW <br /> TYPE i e NCK 1 ale <br /> (Mailing gAddress) FORMS <br /> NOTE <br /> (City, State, Zip Code) <br /> (Area Code - Telephone Number) <br /> Sketch (Detailed plans may be submitted) <br /> a�EE f4TT19Gh�EL1 PL.�i�l,.S' <br /> Pm 3D y,18 9 70 <br /> The undersigned hereby applies for permission to excavate, construct and/or <br /> otherwise encroach on County Highway Right-of-Way on -slap. .aOTf/ Sidesof <br /> AA?14Z .Pb, . approximately 20;tU feet/m�e �,CSj <br /> of LDlj�2 s�9�Ri4n�E.Vl'a .�� A7bCKTDN T by performing the <br /> following work (description of work) : <br /> TI,J JUT/E S <br /> Work will commence on or about for approximately <br /> 4D 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`Ito <br /> inspection and approval. <br /> • - S 2. Gig S EST/�Ji9To,�_ 7. Qb <br /> mat�llre- Of r_,l - RETURN <br /> RMmS TO. Date <br /> MASTER.PS\FEESC-IDL (6/00) <br /> JOB SMGDESK-4040 ftet L"* <br /> BLp 1 <br /> 3TC, A ftV4 <br />