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APPLICATION FOR ENCROACHMENT PERMIT <br /> PLEASE PRINT: <br /> Date OFFICE USE ONLY <br /> To: San Joaquin County JOB # /IDDc REF # <br /> Department of Public Wor74ctro,A <br /> APN CR # <br /> EXP. DATE <br /> h G h VALID 5-•5--98 TO DRIVEWAYS: <br /> (Applicant Name) STREET <br /> c ( / AREA Rn QUAD �_ <br /> O IJ X CJ '7 TYPE G �fDLE <br /> c J J(Mailing Address) !' FORMS 1O <br /> NOTE <br /> (City, State, Zip Code) <br /> (Area Code - Telephone . umber) / <br /> Sketch (Detailed plans may be submitted) <br /> s •e� � lq� s <br /> The undersigned hereby applies for permission to .excavate, construct and/or <br /> otherw'se encroach on County- Highway Right-of-Way-on-the (..fes. - side.of <br /> S ,r 9 rar4 L approximately5-0 ee /mile Sou F� <br /> of rN, F 6""'4 by "performing the <br /> following work (description of w k) : 0 4 �%te <br /> rc �� /l Ole AllC <br /> le 4c Ii c— ., n �• u <br /> Work will commence on or about for approximately <br /> S 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 /> -07-- <br /> -ASig e of Applicant - Title Date <br /> MASTER.PS\FE8SC8DL (6/00) <br />