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APPLICATION FOR ENCROACHMENT PERMIT <br /> PLEASE PRINT: <br /> Date AUG 1 1 Z02 OFFICE USE ONLY <br /> To: San Joaquin County JOB # 7 REF # <br /> Department of Public Works APN CR # <br /> D <br /> VALID <br /> EEA713 OS TO `��lS-SDS DRIVEWAYS: <br /> . (Applicant Name) STRT ,24 <br /> �SSOVA-WIR-lr M7 1157 TTY AE �.t+9/ QUAD �S <br /> (Nailing Address) FORMS <br /> NOTE <br /> (City, State, .Zip Code) <br /> (Area Code - Telephone Number) <br /> Sketch (Detailed plans may be submitted) <br /> SEE MARS AT l A CH1 <br /> The undersigned hereby applies for permission to.excavate, construct and/or <br /> otherwise--encroach on -County-.Highway Right-of-Way,-on-the sidp_' •bf <br /> approximately feet/mile <br /> of by 'performing the <br /> f VARIOUg work S LOCATIONS ption of:work) <br /> RAI SE la Uy E RT AY D GATT IIA vEC� <br /> 0Ct;TS 3/A3"' BELL J-40LE-S <br /> YAR/OUS LOCATIONS O/V EAST SI.DF OF T 1'vVIrl #76/OUO <br /> Work will commence on or'about 'LOT <br /> for approximately <br /> GO days. _ <br /> I, the undersigned certify. that I am the owner' of_ therespective -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 /> C SIE VERS - FOREMAN <br /> Signature of Applicant Title Date <br /> MA9TSR4'SknZSC60L (6/00) <br /> I <br />