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y APPLICATION FOR ENCROACHMENT PERMIT <br /> PLEASE PRINT• <br /> Date OFFICE USE ONLY <br /> To: San Joaquin County JOB #_i �/"?j REF ## <br /> Department of Public Works APN CR" # <br /> Ty We SAon f o Iq rT EXP. DATE t- ') <br /> VALID l-!� TO •l S DRIVEWAYS: <br /> (Applicant Name) STREET 1/4 II/�fl �q,tia <br /> Z300 L- g M;/e �l AREA LtXy ,q QUAD NE <br /> TYPE ,�EiVrff <br /> // (Mailing Address) , FORMS SS 441 �-zi <br /> Slvekon CA j52 to NOTE <br /> (City, State, Zip Code) <br /> 2oq�y7tl <br /> (Area Code - Telephone Number) <br /> Sketch (Detailed plans may be submitted) <br /> SCE A Qa� Due; srn CA <br /> -a �. <br /> -� C= z <br /> A T7 c7'o6 605 /59 0 <br /> CD C:) nM <br /> O cz: <br /> Z Cn <br /> The undersigned hereb), applies for permission to excavate; construct and/or <br /> otherwise encroach on County -Highway Right-of-Way on the <br /> HA1NHY L/1/ side of <br /> approximately SSB' FT mile <br /> of f/Wr $$ ee•by performing the <br /> following work (description of work) : <br /> _MOP, Fbt� F3" OB/20 /T To BE Ufa <br /> FT oKrH f /,� RoPERrY Lrn/£. err w'-11 E•v <br /> o X PGE FbL E. <br /> CAL TAWS Y iC aut0uwES wo & Wea Z A LAA' <br /> Clow—�S �t/E6'a�0. ALL GJoRK <br /> 5"71oula r-Aea PIA,-F OFF HARN" Ln/ AWAY /Tom r dA5e/e, <br /> Work will commence on or about _ TAA/ 15 <br /> 30 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 approva• . <br /> o . <br /> 11%-7 <br /> Signatur of Applicant��4- Title <br /> Date <br /> MASTER.PS\FEESCEDL (6/00) <br />