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APPLICATION FOR ENCROACHMENT PERMIT <br /> PLEASE PRINT• <br /> Date f" L;RVAAV �9 t ZOO K OFFICE USE ONLY <br /> Tc: San Joaquin County JOB # �� = REF # <br /> Department of Public Works APN ,! CR # <br /> c y f EXP. DATE 4-t�—-0F) <br /> AiVANS-0 GE9CE 1Vi tnnmen+QIPVALID - TO 4 -t,5 DRIVEWAYS: <br /> (Applicant Name) STREET AVE <br /> /� <br /> AREA _�i X k rwFJ QUAD �- <br /> _ 'X5_7 574,4w AnA D TYPE <br /> (Mailing Address) FORMS <br /> NOTE <br /> ST(XLK 1:9 N CA 9 51I<- <br /> (City, State, Zip Code) <br /> kZ n) qj7- /ooh <br /> (Area Code - Telephone Number) <br /> Sketch (Detailed plans may be submitted) <br /> P1F,45E. sur aA-a-• Oaf t 0 worK P/Ani PATIO S JANvAr� Z oo7• <br /> The undersigned hereby applies for permission to excavate, construct and/or <br /> otherwise encroach on County Highway Right-of-Way on the SQV T/} side of <br /> F/MW OoD AW sc aproxi ately `100 _(O/mile WAS f <br /> of xr,_ tIsscliel� of Fr"•uOoD VF , FrANKIiw A'V1., by performing th�j <br /> following work (description of work) : NyAnKoMtnt: D F 74AEC_ ��� SOl n �lNKjs <br /> -}oor <br /> 1�}S OF S �� ,�iF�n.�. S.,rJ1AQ 1/QI&F. <br /> Work will commence on cr about r 01 Z 0 O 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 /> /ft" a /0 11 <br /> TQC ul mAN9!4t0orr <br /> A � Z�19� <br /> Signat of Applicant - T:itle Date <br /> MASTER.PS\FSESCHDL (6/00) <br />