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APPLICATION .FOR ENCROACIMIENT PERMIT <br /> RECEIVED . <br /> nr.t�e,gS PRINT: SAN J�OA-QUIN COUNTY <br /> 006 JUN 27 AWP%Orss ONLY <br /> Date <br /> To: San Joaquin County RgE T#OF WORKS REF # <br /> Department of. Public: Works APN CR • # <br /> EXP. DAT <br /> � �.1�?• VALID _1 TO DRIVZWkYS: <br /> (Applicant Name) STREET��I' t, CAMP <br /> AREA QUAD <br /> TYPE. 1ht> <br /> (NailingAddress) FORMS. 55 tM4> <br /> )� �c _!�Z_ 'NOTE <br /> (City, State, .Zip Code) <br /> (Area Code - Telephone Number). <br /> Sketch (Detailed plans may be submitted) <br /> The undersigned hereby applies for permission to .excavate, con eruct d/or <br /> otherwise-enc oach-o County-Highway Right-of-Way-on-the s . <br /> approximately . ) ee mile . ' <br /> of , 1be'r ormiiig the <br /> following work (description of:work) : ' <br /> Work w'11 commence on or'about 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 /> Signatur pplicant - Title ate <br /> �msraa.ps\asssMML (6/00) <br /> i <br />