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.APPLICATION FOR ENCROACHMENT PERMIT <br /> PLEASE PRINT• <br /> Date ' ^ 2 / O ? OFFICE USE ONLY <br /> To: San Joaquin County JOB # //04) REF # <br /> Department of Public Works APN _ CR # <br /> _ ,/ EXP. DATE /�/o-7 X"O e. Z/� f �d E VALID S TO ¢ o9 DRIVEWAYS: <br /> (Applicant e) STREET , <br /> AREA G a "f QUAD �(JC <br /> z'c4„S raly O2 STQ TYPE fS iYi, S LJYy a t <br /> (Mailing Address) FORMS :;a1,C.zuJ <br /> _'4 3 3 C � NOTE <br /> (City, State, Zip Code) <br /> - 327— / ?zy� <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 /> herwise encr5R�ach on County Highway Right-of-Wa ' on the side of <br /> 9s <br /> e i tL L /G approximately J 2 �0 Leet/mile <br /> of �� t�9 T T.tC t LIf , by performing tY�e <br /> following work (descri.,Pt ion of work) : o-- As -e C ?AMt svo-) TO AJ <br /> C ooR Lis d- � LT0 f S R e o � 2 <br /> C6 L Z,4 tie A 6 o✓?-,4 kJe-o-X- , fi lJ7l L7in <br /> Work will commence on or about for <br /> days. <br /> I, the undersigned certify that I am the owner of the respective proper <br /> qualified to represent. the owner and agree to do the work described aboaccordance with the rules, regulations of San Joaquin Cgunty and subjecinspection and apr val. �o d (�h -C T �� <br /> �o44 f �cC irL� G� �te d✓C 1 �/po.✓ ConlPlcTly <br /> o � � Z� ^ ° 7 <br /> Sig re of pplican . - Title _o �s�� J� Date <br /> MASTER.PS\FEESCHDL (6/00) / P/ <br />