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APPLICATION FOR ENCROACHMENT PERMIT <br /> PLEASE PRINT• <br /> Date OFFICE USE ONLY <br /> To: San Joaquin County JOB # -730 -79-.3 REF # <br /> Department of Public Works APN CR # <br /> A <br /> 7-r (,feS¢ol1 EXP. DATE <br /> VALID TO DRIVEWAYS: <br /> (Applicant Name) STREET 1_yULE AVE.vvP. <br /> Z X00 E S is RJ AREA `JTOCA-DU QUAD LV <br /> TYPE 2?4" <br /> (Mailing Address) . FORMS <br /> S1`OC,��nr1 CA 9✓rZ/0 NOTE <br /> (City, State, Zip Code) <br /> 201 Y7y- — <br /> (Area Code - Telephone Number) <br /> Sketch (Detailed plans may be submitted) <br /> S« 4 k.--W ams <br /> Aft J7-o6 Ab <br /> The undersigned hereby applies for permission to excavate; construct and/or <br /> otherwise encroach on County Highway Right-of-Way on the Some i4 side -of <br /> Luede approximately O - 21 y FT tePt/mile EAs7 <br /> of _ t70AJ by performing the <br /> following work (description of work) : ATY To gae /�3�' t73 azo m.va_�117" <br /> 2/y FJ` (J&:r7 To AlrV Tec 5,491 IET ON wesr siDE Or �irf- �1•N�7'f. <br /> Work will 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 /> 0� <br /> Signature ofgaflicant - Title Date <br /> MASTER.PS\FESS®L (6/00) <br />