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APPLICATION FOR ENCROACHMENT PERMIT ] <br /> PLEASE PRINT: <br /> Date J OFFICE USE ONLY <br /> To: San Joaquin County JOB# 0pSY SREF# <br /> Department of Public Works APN CR# <br /> EXP.DATE 12!--1—2 C.",I ti <br /> PG&E VALID .l-1.< 2oI,4TO 2 DRIVEWAYS: <br /> (Applicant Name) STREET QJ, ` <br /> AREA � - _0 yQUAD _ <br /> 8 RIVER PARK PL E TYPE r <br /> (Mailing Address) FORMS , �Z��_ <br /> NOTES <br /> FRESNO CA 93720 _ <br /> (City,State,Zip Code) <br /> (559)347-5008 <br /> (Area Code-Telephone Number) <br /> Sketch(Detailed plans may be submitted) <br /> SEE ATTACHED SKETCH <br /> The undersigned hereby applies for permission to excavate,construct and/or otherwise encroach on County Highway Right-of-Way on <br /> the EAST side Of DROGE RD. approximately '4 -jC mile NORTH <br /> Of MARIPOSA RD. J ESCALON ,by performing the following work(description of work): <br /> REPLACE DETERIORATED UTI RY POLE <br /> Work will commence on or about 7/97114 for approximately __ i 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 /> Signature of Applicant-Title Date <br /> 1"::WUM1SY]YphlAS7ERP5LN^.ROACtISGJIF PE1thG�h°FUCATIO4.DOC[OCAS) <br />