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APPLICATION FOR ENCROACHMENT PERMIT <br /> PLEASE PRINT: <br /> Date <br /> _� pa����o OFFICE USE ONLY <br /> �3 -- <br /> ---- F# <br /> # //D��j� RE -- <br /> To: San Joaquin County JOB JOB RE# <br /> Department of Public Works APN <br /> EXP.DATE DRIVEWAYS: <br /> Ua I t � �� 1 tt�f t:�VI c,�s VALID TO 7J�=08 <br /> (Applicant'Name) STREET 'eD --- <br /> (� AREAlaL'k7O�(/ QUAD _— <br /> rI-7Tf21 &AM RA SU�• �3 TYPE ?,e6AI � -- <br /> (Mailing Address) FORMS <br /> NOTES <br /> CP, <br /> (City,State,Zip Code) -- <br /> (Area Code-Telephone Number) --- <br /> Sketch(Detailed plans may be submitted) <br /> SEn-�c .p <br /> - ' A-r- ,c F0 14 n <br /> h Right-of-Way on <br /> The undersigned hereby applies fqr pe fission to excavate,construct and/or County Highway Rig ay <br /> the NtA'RT)A side of ll�� f I R© approAmatdy. feettmile 6S�k <br /> of T R�1 G 9 3 19-6f144 t9F �'r" � by performing the following work(description of work): <br /> -Fo N s -r_ — U d Pr <br /> V'Aw+ Fn2 pQ w 2 <br /> �-- � � � <br /> r-og FELE h �� I.U�.+4T 1 O r� N p-ep. <br /> Fo rz Mr 11 ' i� CO�' l4Gt E Ro 14 D -- <br /> Work will commence on or about - for approximately days. <br /> I,the undersigned,certify that I am the owner of the respective property,or am qualified to represent the owner and agree to do the <br /> work described above in accordance with the rules and regulations of San Joaquin County and subject to inspection and approval. <br /> ure of Applicant-Title Date <br /> -sem <br /> F:IPUBSVAN <br /> .WKISTER PSENCRQ4CHMENT PERWT APPI.ICATION,DOC(O141a�� <br />