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p,PPLICATION .FOR ENCROACMdZNT PERMIT <br /> - PLE-�SL PRINT <br /> OFFICE USE ONLY <br /> Date <br /> JOB # //CoS REF # <br /> To: San Joaquin County APN CR # <br /> Departm of Public W ke EXP. DATE <br /> j VALID TO F33=n 7 DRIVEWAYS:. <br /> ST" U . STREET L ,4i�yt7�G ST <br /> ( gliE e) AREA QUAD �S <br /> (� _ <br /> TYPE <br /> FORMS SS' ww <br /> (mailing Addresa) NOTE <br /> CAI)�ty'--- <br /> (CiState, -Zip Code) <br /> (Area Code - Telephone Number) . <br /> Sketch (Detailed plana may be submitted) <br /> The undersigned hereby applies for permission to .exoahee, �4�sb}uctgior �f <br /> Th <br /> o hee enc oachn .County.Highway Right-of-Tn�aty os; feet/mile <br /> approximately . by pez€ rmirig the <br /> . <br /> of ------------ <br /> i <br /> following work (description of:work) : <br /> for approximately <br /> Work will commence on or'about <br /> days. <br /> ed certify. that I am the owner in. <br /> respective property, or am <br /> I the undersign Y. <br /> qualified to represent..the owner and .agree to. do .the work described <br /> sub�cteton <br /> accordance with the rules, regulations *of San Joaquiin County <br /> ins ection and app Val. <br /> Date. _.. <br /> Si ature of icant Ti <br /> MASTffiL.RS\BBB$®L (6/00) <br />