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APPLICATION FOR ENCROACHMENT PERMIT <br /> PLEASE PRINT: <br /> Date Il- (o / OFFICE USE ONLY <br /> To: San Joaquin County JOB ## 1/005 REF # <br /> Department of Public Works APN CR # <br /> �D <br /> /I <br /> EXP. DATE ✓� 97U7 BEY T L 14T-6/Z R E_ VALID / TO ! 5 1;-7 DRIVEWAYS: <br /> (Applicant Name) STREE j Zinn. CV <br /> J09-3 SPOV C, I ��� LE_ TYEA PE 4 <br /> UAD 5U) <br /> 1, ' lSnie (- <br /> (Mailing Address) FORMS _ S!:; <br /> NOTE <br /> (City, State, Zip Code) <br /> SZ - / 011 <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 0 RT Lt side of <br /> SRP N T_ L I 1 F Rn approximately 2000 F7. fee /mile <br /> of �v�di`°�' ��r' /' byperformingthe <br /> following work (description of work) Z (/ C UWl Yvl SX TR I�CT I D1U <br /> STT 14oL NC -r(1 Ilh�2i Fy / nCil-T1ON U1- 1)TIL1r� lcN�vazo cINF ) <br /> Work will commence on or about - _S for approximately <br /> 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 approval. <br /> ignature of Applicant - Title Date <br /> MASTER.PS\FEES CIML (6/00) <br />