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APPLICATION FOR ENCROACHMENT PERMIT <br /> PLEASE PRINT: <br /> Date ' ` ` ` J --- OFFICE USE ONLY <br /> To: San Joaquin County JOB # i )066-' REF # <br /> Department of Public Works APN CR' # <br /> t! EXP. DATE <br /> �M \„ VALID or) 5-2a_7o r-1-06 DRIVEWAYS: <br /> (Applicant Name) STREET <br /> AREA <�i cry J<T 6�`�QUAD /YE <br /> 4 � �jm') � Q _DU 6 <br /> TYPE 'F - <br /> (Mailing Address) FORMS <br /> NOTE <br /> (City, State, Zip Code) <br /> (Area Code - Telephone Number) <br /> Sketch (Detailed plans may be submit ed) Q�4 <br /> � <br /> The undersigned hereby applies for permission to excavate, coistruct and/or <br /> herw,ise ncr ach on County Highway Right-of-Way-on-the side of <br /> approximately fee /mile <br /> of t � by performing the <br /> following ork (description of work) : ra <br /> x,11UrVEH <br /> I <br /> Work will commence on or about i�Y1 for approximately <br /> '�Io 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 /> Waw �l <br /> Si ature of Applic Title Date <br /> 14A.S=R.2S\?39SCHDL (6/G0) <br />