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APPLICATION FOR ENCROACHMENT PERMIT <br /> PLEASE PRINT: <br /> Date k OFFICE USE ONLY <br /> To : San Joaquin County JOB # °'(2✓�b`j�- REF ## <br /> Department of Public Works APN CR <br /> EXP. DATE / 1 <br /> r � VALID d Z Io TO i Lai! DRIVEWAYS: <br /> (Applicant. Name) S&Eu LE Q.U. <br /> QUAD SF <br /> TYPE �- <br /> ORAS BaDIcE P►+� <br /> (Mailing Address) FORMS SS <br /> S-i-0 V f r,_,a,� 3 t Ci NOTE <br /> (City, State, Zip Code) <br /> -14 <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 on the +,%%LSo side -of <br /> t As ,LiL approximately 1G%c>` feet/mi! So m <br /> following work (descrby performing the <br /> ipt:ion of work) : ►3csei� D �'t 4c Sit 0 t= I <br /> 1 ti"- 0Nrt- iii }i ti� tit�sC ' a t� ri t� <br /> Cw�tS�,,Q.IC �T �7e,7 t Iz- tE"Hflm��Cr T� Ca Ll 5 <br /> Work will commence on or about _ t4o\j 4,)_ 4 } g L� <br /> 311 days. for approximately <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 /> Signature of Applicant - Title <br /> Date <br /> MASTER.PS\FERSCEDL (6/00) <br />