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APPLICATION FOR ENCROACHMENT PERMIT <br /> PLEASE PRINT: <br /> Date (� 1° Y� OFFICE USE ONLY <br /> To: San Joaquin County JOB # 005 REF # <br /> Department of Public Works APN - - CR # <br /> EXP. DATE <br /> VALID ,�) ] TO 90 UQ J6 7 DRIVEWAYS: <br /> (Applicant Name) STREET C04er- 1Z0 <br /> /� AREA QUAD S_ <br /> An �'� ose1YL1l�2 Jul/Q SuAlyz A TYPE _'��.4�� WCL _1"r���U �Y <br /> (Mailing Address) FORMS <br /> NOTE P IL - 0 <br /> Oo.l ob LA G 53CP 1 bo4 ' a. s <br /> (City, State, Zip Code) <br /> Lo26G- g�] - '_6-]a ce R� a'0u <br /> (Area Code - Telephone Number) <br /> Sketch (Detailed plans may be submitted) <br /> 5a' Bmf rm'mvt� lan S <br /> The undersigned hereby applies for permission to excavate, construct and/or <br /> otherwise enc ro ch on County Highway Right-of-Way on the !E-0 k side of <br /> 40'r [zoa approximately feet 46,fi> c6(,S4 <br /> of e)yLUTG\ -P"30A cr—C by performing he <br /> following work (description of work) : (^OYtS u!'.�lYtn. n 1 o P. rpadL&t A s <br /> �vcm drGti h ,1(llG'�I�iP e <br /> Work will commence on or about -7 1301 D for approximately <br /> 0,c 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 nd approval. / <br /> ignature of Applicant - Title Date <br /> MASTER.PS\PEESCHDL (5/00) <br />