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APPLICATION FOR ENCROACHMENT PERMIT <br /> PLEASE PRINT: <br /> Date 0-7 OFFICE USE ONLY <br /> To : San Joaquin County JOB #, �vREF # <br /> Department ofPublic Works APN CR # <br /> f <br /> - weS�d1 OSPE EXP. DATE 7� 1-o 7 <br /> A T7 To � VALID A so -'7 TO -/- DRIVEWAYS: <br /> (Applicant Name) STREET * <br /> Z Soo E YM"- ! AREA G F D QUAD <br /> TYPE lJNV G-A& C4cF�tt <br /> (Mailing Address) FORMS <br /> // NOTE <br /> (City, State, Zip Code) i" - <br /> (Area Code - Telephone Number) Ej 471 <br /> Sketch (Detailed plans may be submitted) <br /> CEtc-�TE � <br /> -may ��RFF+G yf�ALL 1 - ' 3v3 E Live o'� At Ul <br /> �'�C�!✓C� Mast/-"-4006W6 //4 ,� . 4 <br /> &VEoa,� <br /> �� _" <br /> The undersigned hereby applies for permission to excavate,- construct and/or <br /> - otherwise encroach on County-Highway-Right-of-Way on the -• dogT / side -of <br /> Lly e- o.4X RoAp approximately �ee /mile EAST <br /> of ACPNC RAZ) 1 , by performing the <br /> following work (description of work) : 477 ro $Lock LAA/-r <br /> div oitDE-/Z Ta 6,vtve o j -nri eo FAc IL I T'l� Coe-,4 TE,D, oy i✓4tc i '_IrrY A Y <br /> -rc Cu/ ,ri7r LoeA TCv -aE. N° �.,vST2v crlo.AJ &/,;/ & ovl 00v,,yrr _2or,-/, Al/ <br /> tie%rK in_ P/', f• P Y77%-P k No- n dvl j. All fo C,4 t_nM us r)W, L AAJE X1 oek/,e/( Wye! <br /> 11or Ive Cnrrf a&js . (x �� o�I and o✓►, <br /> Work will commence on or about 14tzIL 3o for approximately <br /> 145 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 /> Signature o Applicant - Title baie <br /> MASTER.PS\FEESCHDL (6/00) <br />