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APPLICATION .FOR ENCROACE[MENT PERMIT <br /> vr.gaisS `PRINT: <br /> Date 0 OFFICE USE ONLY <br /> To: San Joaquin County JOB # Mao 5 REF # <br /> Department of Pub is orks APN CR ' # <br /> EXP. DAT eh 16 (41 <br /> L _ Q , CS VALID �T TO FJ1A& DRIVEWAYS: <br /> (Applicant Name) STREET . n <br /> AREA 57ZA1 QUAD <br /> TYPE h n <br /> ! <br /> (Sailing Add==s s e) FORMS. <br /> NOTE <br /> (City, State, Zip Code) <br /> • 2.01--��3 -l�`� t Z <br /> (Area Code - Telephone Number). <br /> Sketch, (Detailed plan may be submitte ) -y z*,., S-e4u lcrro <br /> Sen C/ <br /> The undersigned hereby applies for permission to.excavate, construct and/or <br /> otherwise-enc eea h on County,-.Highway Right-of-Way--on-the s'id�. f. <br /> approximately 2.a4 feet/mile <br /> of by"performing the <br /> following work (descr tion of:work) : JL113 -el L 1 -4 ` 4 s N: -� ���¢W <br /> Work will commence on or'about 1N kut-, 7-3 'a 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, .requlations 'of.San Joaquin county and subject to <br /> inspection and approval, <br /> Signature of Applicant - Title Date <br /> !mb'TSR.pS\nUCEDL (6/00) - - - - <br /> `l <br />