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APPLICATION FOR ENCROACHMENT PERMIT <br /> PLEASE PRINT: <br /> DateL,—,Q 2- OFFICE USE ONLY <br /> To: San Joaquin County FEXP.DATE <br /> /Q�� REF# <br /> Department of Public Works CR# <br /> 1 �� 7- <br /> \A +� !- L.l l <br /> (Applicant Name) STREET 2 T y DRIVEWAYS: <br /> .�O �; <br /> --ii AREA �s <br /> TYPE <br /> (Mailing Address) FORMS _� Z <br /> i Q CA CT 5-( 1 NOTES <br /> (City,State,Zip Code) <br /> (Area Code-Telephone Number) <br /> Sketch(Detailed plans may be submitted) <br /> 5 C - C Cts , S` � ►C�c1 , nc, <br /> i�ot t- <br /> 10- 64AvP Y? Ae A,141--s 4 -'0 a A,41, 4. <br /> The undersigned hereby applies for permission to excavate, construct and/or otherwise encroach on County High Right-of-Way on <br /> ththe.�i�'t _ <br /> rrt St Mc d�1 C �T _T approximately (c;C% fe mile f --Jn <br /> ns �� — - � IL i N by performin the following work(description of work): <br /> fit:' lr,z) (c� <br /> " 1 t GF :tom r U� <br /> �� � _( fat' c� �Gc;; e <br /> 12S CT �. <br /> UB t �hc Chi^�C.l it k `1'U <br /> Work will commence on or about 1 ..1. for approximately <br /> 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 /> tOLI <br /> Signatu of Applicant-Title Date <br /> E1PU13-SV.WKWMTERPSIENCROACHMENT PERMIT APPLICATION.DOC (01/08) <br />