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APPLICATION FOR ENCROACHMENT PERMIT <br /> PLEASE PRINT^ <br /> Date 2 <br /> OFFICE USE ONLY <br /> To: San Joaquin County JOB # n3002q-__2_> REF # <br /> Department of Public Works APN CR # <br /> EXP. DATE (0-1-09 <br /> /�/ / /✓ /~%G _ <br /> VALID-5--l'-09 TO r0-I+A� DRIVEWAYS: <br /> (Applicant Name) STREET <br /> �� �E�l�rr,V,Ac.r.3 RZ>, <br /> CTG ,c� AREA aL��S QUAD - — <br /> C -rf�l TYPE JCE P8? k•Q' <br /> (Mailing Address) FORMS <br /> NOTE <br /> clv <br /> (City, State, Zap Code) <br /> C -e- <br /> (Area <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 K�Dt2.,+K side -of <br /> U-) approximately YY1 I t_C feet/mile € .�'L' <br /> of C'�Rl 5 t-'1/�R P-b 'J 1 �,. ) by performing the <br /> following work (description of work) : <br /> 1.71 <br /> �R4jZ. 701 <br /> 4ht= s <br /> _0Ci P,c.k <br /> 1�t`�t�.�T t C.� CSU r��n�i�i G r� Cxy� 12 L i �T S �'Tl:. � ��►�_xx' �-� � r2 r1.����S <br /> �fl <br /> Work will commence on or about 'C C1 for approximately <br /> Q_ days. <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 f% App is nt - it /Date <br /> MASTSR.PS\"eHSL (6/ <br /> r, <br />