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APPLICATION FOR ENCROACHMENT PERMIT <br /> PLEASE PRINT: <br /> OFFICE USE ONLY <br /> Date yy <br /> J0B l �� REF <br /> To: San Joaquin County CR rt <br /> artmerat of Public Works <br /> zpN <br /> EXP. DAT 2 _ <br /> VALID S TO /S DRIVEWAYS: <br /> (APplic nt Name) <br /> STREET <br /> O / AREA IY..AI QUAD <br /> 9 <br /> TYPE <br /> (railing Address) FORMS 5 <br /> NOTE <br /> (city, Zip Code) <br /> (Area Code - Telephone Number) <br /> Sketch (Detailed plans may be submitted) TRAFFIC CONTROL IT :." <br /> SHALL BE AS PER <br /> CURRENT M.U.T.C.D.� o <br /> CALIFORNIA SUPPL§tAEKT C:M <br /> -see a46-zi <br /> X Cn d <br /> The undersigned hereby applies for permission to excavate, constrnc and/or <br /> side of,A- <br /> o wise se e roach on County <br /> Highway Right-of-Way on the feet/ <br /> approximatel <br /> by perfprmi t e l <br /> o f —t'[� <br /> collo g wgrk. (description of work) : <br /> G7 for approximately <br /> Wor will commence on or out <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 n.Les, regulations of San Joaquin County and subject to <br /> inspection nd approval: <br /> Date <br /> .f T-...yr+ - T-.ti <br />