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APPLICATION FOR ENCROACEMENT PERMIT <br /> PLEASE PRINT• <br /> Date � � OFFICE USE ONLY <br /> To: San Joaquin County JOB # 7-3.6 b ( REF # <br /> Department of Public Works APN CR # <br /> EXP. DATE U- 1-- O q <br /> �►"�1-1�0���� �`Y � 5 �� VALID TO 11-I "n_Z DRIVEWAYS: <br /> (Applicant Name) STREET kA G&F %%Aq 1n 1-"\ STI <br /> �* AREA Z70 CC Q AD E <br /> TYPE <br /> (Mailing Address) FORMS 2 53W. <br /> pc� �p q NOTE <br /> (City,y, S�tnate(,, .Zip Code) <br /> (Area Code - Telephone Number) <br /> Sketch (Detailed plans may be submitted) <br /> The undersigned hereby applies for permission to.excavate, construct and/or <br /> otherwise-encroach on •County•Highway Right-of-Way•o.n•the .�� k\ sids:.of <br /> dN►G`�6� Ste'- approximately feet/mile <br /> of by "performing the <br /> following work (description of.work) : <br /> g sl <br /> IiNMv-kICY - Acle SFP <br /> Work will commence on or_ `about 0.1 - OA"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 regulatio of San Joaquin County and subject to <br /> inspection and approval. C\� <br /> Signature of Applicant Title Date <br /> MASTHR.PS\FRRS®L (6/00) <br /> i <br />