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APPLICATION FOR EN'CROACH'MENT PERMIT <br /> PLEASE PRINT: <br /> Date 1 2 — Z 1 ' 4� oa'FICE USE ONLY <br /> To: San Joaquin county O13-# /305Z—�5 REF # <br /> Department of Public works APN Cit' # <br /> AXP. DATE <br /> TO'�" c��— DRIVEWAYS; <br /> (Applicant Name) STRBIE T RDS. <br /> AREA frA: ZkZO QUAD ✓c * -----�-� <br /> TYPE <br /> (Mailing Addreaa) <br /> � �3�20 rroTE <br /> (City, gtate, Zip -Code) <br /> X5.2- 34-7 - <br /> (Area Code - Tolephone Number) <br /> Sketch (Detailed plana may be submitted) <br /> 5- <br /> (13 <br /> CD <br /> She undersigned hereby applies for Permission to exc"ate, construct and/or <br /> hQrwise encroach on County Hi�rlaway bight-of-Way on the /4gtoo side of <br /> V1 b mximately 2 040 ea . &as <br /> ' <br /> of by `performing the <br /> �G n ��/- <br /> following work (description of work) �������--4,f 4 1 114 ' c.. <br /> Work will commence on az about <br /> for approximately <br /> �` , '5: — days <br /> T, 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, regulatiOn8 of San joaquin county and subject to <br /> inspection and a prOva:1. <br /> Z76 <br /> Dte <br /> Signatures of Appy ca t - Title <br /> f4ASTgR.P6\FZE8CHDL (6/00) <br /> Z8/Ze SJdd SiIHJOd O00S VzC689VGK7 ZO :PT 899Z/LZ/Z0 <br />