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APPLICATION FOR ENCROACHMENT PERMIT <br /> PLEASE PRINT• <br /> Date J �"� <br /> FFORMSLXO <br /> FFICE USE ONLY <br /> To: San Joaquin County <br /> Department of Public Works REF <br /> CR' <br /> 0On' _ 7 <br /> ^ =,C :Jc v ^-T = ^ C -1[� <br /> G TO 5- G�,_ DRIVEWAYS: <br /> (Applicant Name) .ei l-�Ci�_' 1�, QUAD(Mailang Address) Ltxd>�,�cJC�a <br /> (City, State, Zip Code) <br /> l?C9 i ? �E-09 C( <br /> (Area Code - Telephone Number) <br /> Sketch (Detailed plans may be submitted) <br /> The undersigned hereby applies for permission to excavate, construct and/or <br /> otherwise encroach on County Highway Right-of-Way on the <br /> side of <br /> of 'd., '1 approximately feet/mile <br /> folilowing wozk (description l�a �a; _ _ I by Performing the <br /> 00777_ _'!_':� L Cp''T�1` vork) 2 i L_ tTE—cOra 'y c ,'^ -, e <br /> n 8 %u' O Q a i7--an-T07=1 +"_' , <br /> Work will commence on or about 1 � 0 <br /> days . for approximately <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 _e <br /> inspection and approval . <br /> Douglas Colucci .317/d7 <br /> S u e of Applicant President, Board of Directors Date <br /> Woodbridge Sanitary District <br /> KASTER.9S\BEESCHIJL ;6/00) <br />