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APPLICATION FOR ENCROACHMENT PERMIT <br /> PLEASE PRINT: <br /> Datey2 t� COFFICE USE ONLY <br /> To: San Joaquin County JOB # REF # <br /> Department of Public Works APN CR # <br /> /U EXP. DATE <br /> 0 '"� (-�� �'� "' VALID TO DRIVEWAYS <br /> (Applicant Name) STREET <br /> I Zo ��� ^ � �� AREA QUAD <br /> f-� TYPE <br /> /-� (M iling ddresss)) FORMS <br /> NOTE <br /> (City, State, Zip Code) <br /> (Area Code - Telephone Number) <br /> Sketch (Detailed plans may be submitt d) <br /> The undersigned hereby- applies for permission to excavate, construct and/or <br /> otherwise-encr ch on County Highway Right-of-Wa on thevi Kid side of <br /> C�,.42c�K.n.� approximately �' 'Trs �ZZS�T. feet/mile <br /> of I k4�+ by `performing the <br /> following work (descri I <br /> tion of work) • wS�-rT� -�c�,�o 1,(� `, i�02 <br /> O�TZr <br /> Work will commence on or about 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 /> Signatu e f Applicant - itle D to <br /> MASTER.PS\FEES CEDT, (6/00) <br />