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PA <br /> APPLICATION FOR ENCROACHMENT PERMIT <br /> PLEASE PRINT: <br /> Date -23*11 l OFFICE USE ONLY <br /> To: San Joaquin County JOB # //OOS REF # <br /> Department of Public Works APN OB7 - 220-63 CR # <br /> EXP. DATE 5-(_08 <br /> VALID '?-?-+-o7 TO 5-I-08 DRIVEWAYS: <br /> (Applicant Name) STREET Ca/f� C�, <br /> AREA SforlGLcn QUAD &45 <br /> TYPE <br /> (Mailing Address) FORMS SS/cvw 2-29 <br /> ,G �`� NOTE <br /> (City, S�`t-aLtee, Zip Code) <br /> el 4( L -2-(.,:-, t) - <br /> (Area Code - Telephone Number) <br /> Sketch (Detailed plans may be submitted) <br /> Lv <br /> ey <br /> The undersigned hereby applies for permission to excavate, construct and/or <br /> otherwise enc�oach on County Highway Right-of-Way on the side of <br /> —r approximately Z fee mile <br /> of b� iLC 6 _ by performing the <br /> following work (des iption of wor ) : <br /> Work will commence on or about _c Ts� -=` for approximately <br /> I ,;L days . <br /> A , i '2 <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 /> Signat pplicant - Title ate <br /> �, MAST ,F S=L (5/00) <br />