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APPLICATION FOR ENCROACHMENT PERMIT <br /> PLEASE PRINT- <br /> Date 9-21-07 OFFICE USE ONLY <br /> To: San Joaquin County JOB # AdJ REF # <br /> Department of Public Works APN CR # <br /> EXP. DATES'- <br /> Woodbridge Irrigation District VALID /O-Z-07 TO DRIVEWAYS: <br /> (Applicant Name) STREET Co&xg- y��P:PAd 171®kms. <br /> AREAbDbel QUAD <br /> 18777 North Lower Sa.c . Road TYPE L°Cit°i4 .G/G�Yi��AT�a✓ # �Bi�n/�/ � <br /> (Mailing Address) FORMS <br /> NOTE <br /> Woodbridge , CA 95258 <br /> (City, State, Zip Code) <br /> �noly �il' <br /> 209-369-6808 <br /> (Area <br /> (Area Code - Telephone Number) <br /> Sketch (Detailed plans may be submitted) <br /> See Attached Exhibit List including plans and <br /> specifications . <br /> The undersigned hereby applies for permission to excavate, construct and/or <br /> otherwise encroach on County Highway Right-of-Way on the side of <br /> approximately feet/mile <br /> of 1 , by performing the <br /> following work (description of work) : Please 2QQ QXhib!.tS <br /> work will commence on or about October 1 , 2007 and completed for approximately <br /> May 1 , 2008 nays. <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 /> 9-21-07 <br /> Signature of Applicant. - Title Date <br /> MASTER.PS\FEESCHDL (6/00) <br />