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F=F� , <br /> APPLICATION FOR ENCROACHMENT PERMIT FRESNO <br /> PLEASE PRINT:' MD/pp, <br /> Date I-'L1I L_� OFFICE USE ONLY <br /> To: San Joaquin County JOB# REF# <br /> Department of Public Works APN _ CR# <br /> _ EXP.DATE <br /> s-� y., VALID /r /3 0 / /3 DRIVEWAYS: <br /> (Applicant Name) STREET <br /> _ AREA ��► QUAD /V(5 <br /> x2- . t L TYPE fc, e <br /> (Mailing Address) FORMS w%A) <br /> NOTES <br /> CA <br /> (City,State,kip 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 otherwise encroach on County Highwa R <br /> %.14V- Right-of-Way on <br /> the t side of_Adel wl� �O approximately ��� mile <br /> of ik� iii , by performing the following work(description of work): <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 /> ant-Title Date <br /> EIPUMV.IMIASMRPS8CROACHbL--WPMWAPRJCATI011DDC(01!08) <br />