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APPLICATION FOR ENCROACHMENT PERMIT <br /> PLEASE PRINT: <br /> Date <br /> OFFICE USE ONLY <br /> To: San Joaquin County <br /> Department of Public Works JOB # REF # <br /> _ APN CR" # <br /> EXP. DATE <br /> 51 <br /> (Applicant Name) VALID .ted? TO ��-•/-cti <br /> y0c' ,�k}t�I�l,tnd — — D <br /> STREET RIVEWAYS: <br /> AREA s�rrt c, iUAD <br /> (Mailing Address) TYPE <br /> FORMS STIJLE/, - <br /> -s'�OG'/C7'�,�/ NOTE <br /> (City, State, Zip Code) <br /> (Ar a Code - Telephone Number) <br /> Sketch (Detailed plans may be submitted) <br /> n5"LL jjf't,e ErG , TRAFFIC CONTROL PLAN <br /> SHALL BE A5 PER <br /> CURRENT M.U.T.C.D. <br /> FETIAN mRmrm To: <br /> CALIFORNIA SUPPLEMENT <br /> f ;F3ov�s'� �s <br /> PPocEssrNG DESK- BLD I <br /> 4W WON LMM <br /> IS I XrON, CA 9004 <br /> The undersigned hereby applies for permission .to .excavate <br /> otherwise encroach on County Highway Right-of-yia <br /> FfZE/UCI� .Ggyy)� construct and/or <br /> L�. Y.on.-the A1UteT!-1 <br /> of /SIR/odRT aPProximatel side.of <br /> Y /!/S feet/+&i-}e <br /> following work (description of work -_ <br /> �/4S' /'!9/0!Al ) LXC.`9�Jn, TE by Performing the <br /> 7aORO ao <br /> ,C r' L/A--/, , <br /> Work will commence on or aboC/out <br /> days. for approximately <br /> I, the undersigned certify that I am the o <br /> qualified to represent the owner wrier of, the respective Property, <br /> and agree to do the work described above in <br /> accordance with ther am <br /> rules, regulations of San Joaquin County and subject to <br /> inspection and approval. <br /> S ature <br /> or <br /> Applicant Title <br /> tMTM.Ps I WV ?. .•:°� (llijl Date <br /> �nZS®L (6/00) _ _ <br /> I <br />