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.APPLICATION FOR ENCROACHMENT PERMIT ' <br /> PLEASE PRINT: <br /> Date <br /> _— — OFFICE USE ONLY <br /> To: San Joaquin County FF.RMS <br /> 05?--(gyp <br /> Department of PL.blic Works REF # <br /> CR" # <br /> p <br /> 0 TO 15 Oft_ DRIVEWAYS <br /> (Applicant Name) r�-rnNy gel <br /> o 1CtMr,/ QUAD IFS <br /> / iC - + � <br /> (Mailing Address) <br /> /o'I• Q o NOTE <br /> (City, State, Zip Code) <br /> (Area Code - Telephone Number) <br /> Sketch (Detailed plans may be submitted) <br /> I <br /> 3j 17 <br /> The undersigned hereby applies for permission to excavate, cons ruct and/or <br /> otherwise encroach on County Highway Right-of-Way the <br /> ` side of <br /> Of approximately feet <br /> fQllOwing work_ (description of work) : by performing the <br /> - I <br /> Work will commence on or about _ <br /> +ems days- for approximately <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 /> i <br /> ---—------------ _ <br /> ► � <br /> JSiature of Applicant - '6 �Title <br /> TDate <br /> FEESCHDL (6/00) F1AMN PERMTO: <br /> JOB PROCES&NG EWW_BW 1 <br /> '100'West LarN <br /> CJ1952" <br />