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APPLICATION FOR ENCROACHMENT PERMIT <br /> PLEASE PRINT: <br /> r_ c7 <br /> Date L o OFFICE USE ONLY <br /> To: San Joaquin County JOB # "� �� 3 REF # <br /> Department of Public Works APN CR # <br /> �j C/ WC'S�vn EXP. DATE <br /> ! T VALID3--( -108 TO DRIVEWAYS: <br /> (Applicant Name) STREET T�e z-.:.�H l t`J6 AVE.. <br /> AREA �5 IGTi�C( QUAD /I/ <br /> ZSCJc7 E x l��jc 42 D: TYPE Cs <br /> (Mailing Address) FORMS , e% <br /> 1/ NOTE <br /> (City, State, Zip Code) <br /> Z©1- - y� y ys'6 <br /> (Area Code - Telephone Number) <br /> Sketch (Detailed plans may be submitted) <br /> �+� l t"Cr7G�Celvrt�, <br /> U6 c O <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 ��O fee /mileyu�h <br /> of '906_6�01J4 by performing the <br /> following work (description of work) Iq T r 5Ss.kAya <br /> /v /✓t to 66in7� . P/--<< Co� <br /> �Rr, ��;n�{ {� Ca6/✓el. �7vI� !ri 6etT411M /7eTJ Uric%ii pok . rdC n <br /> /, cJ lti /6/'T POE <br /> Gfn� Cont/ c20W R</z ow Sum;'Zr5- V;5S 11-r' 4e�/tn (Psi2l / of Co�S�rx¢;o� �f��i✓s' ��"cJJ+'7c'c <br /> Work will commence on or about 1'7G�Zook' for approximately <br /> so 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 proval. <br /> Fhhi h ec J c5' <br /> Signftfure of Applicant - Title ate <br /> MASTER.PS\FEESCHDL (6/00) <br />