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APPLICATION FOR ENCROAMOM pgRMIT <br /> RECEIVED <br /> PLg est PRI SANJO-AQUINCO'UNTY <br /> 9 OFFICE USE ONLY <br /> Date REF # <br /> EPT. OF 'U'L'C WO LOB # " -- CR # <br /> S� Joaquin CountyQ APN <br /> To: 3 p <br /> Department of Public Works EXP. DATE DRIVEWAYS 3. <br /> �0 0(o To 3 a <br /> VALID � �n1Jwl(' 8121--- <br /> . <br /> STREET � <br /> liEanName) AREA STRE — <br /> (App t �stoc,�-- QUAD w—5 <br /> FORMS <br /> (mai iag Addseae) NOTE <br /> I <br /> (City, Sbate, -Zip Code) <br /> (Area Code - Telephone Number) <br /> I <br /> lash§ may be submitted) <br /> Sketch (Detailed p � <br /> F <br /> CoNS+ o <br /> o p 0 oS� J�►� <br /> 06 <br /> o L I <br /> i <br /> 0 ov5� <br /> L): <br /> F <br /> nat t and/or <br /> ed hereby applies for permission to .excavate, -side!.of, <br /> The undersign ht-of-Way the `ti/f �+ <br /> of rwise encroach © County Highway Rig feet/mile <br /> approximately y per€ormirig the i <br /> of tion of w rk) : <br /> following work (des P _ III <br /> for approximately <br /> Work i commence on or about <br /> r I <br /> days <br /> ctive property, or am <br /> I, the undersigned certify. <br /> that I am the owner af.the respe <br /> of San Joaquin County and subject to <br /> qualified to represent.the owner ano�gree to do .the work described above n <br /> accordance with the rules, regulat <br /> inspection and approval. <br /> Date <br /> Signature of Applicant Title <br /> MASTER.P6\PMCE[DL (6/00) i <br />