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APPLICATION FOR ENCROACRMENT PERMIT <br /> PLEASE PRINT: <br /> OFFICE USE ONLY <br /> Date /D- 30-0.5H <br /> JOB #_13050 5Z FIEF #_, <br /> To: San Joaquin County CR n <br /> PSN — <br /> Department of Public Works Epp DATE ^S <br /> I'�0 DRIVEWAYS: <br /> t��C✓/�f'Ct�sl`l4! 0 � /. ��i VALID �t`1i` TO � g � <br /> (Applicant Name) A^ <br /> STREET F�LyrY1011lN RLQ. <br /> AREA _,T0CJrMrJ QUAD <br /> TYPE <br /> yo �$LRLL E "yo t.,�Es r u4h/c - <br /> (Mailing Address) FORMS - <br /> NOTE <br /> STDCKTI !�Gl4 9510 / <br /> (city, State, Zip Code) <br /> (Area Code T lephone Number) <br /> ,T <br /> U <br /> Sketch (Detailed plans may be submitted) -t C_n <br /> SELF 4IZO D 1:2L XAJI <br /> p�L Ln <br /> N ' <br /> Ph'1 3oy32s'yS <br /> The undersigned hereby applies for permission to excavate, Econstt�ruct andide of <br /> otherwise encroach on County Highway Right-of-way ons�t�he feet/ NORTH <br /> /lQ <br /> t�Ly/j')ouTN /e _i— approximately --- <br /> t STOC'1C 9AI by performing the <br /> of tlr'L RID <br /> following work (description of work) <br /> EXCr4[//9 TE L L /�O L c Q iJLr" Ll4S iy!/0IAI /q IiI�ST <br /> LIM <br /> for approximately <br /> Work will commence on or about _ <br /> 9O days <br /> I, the undersigned certify that I am the owner of the respective property, or am <br /> qualified to rep:cesent 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 /> --- -- . <br /> --- — <br /> - ----- <br /> ' - - S2. t�X1.S F� I/rlr9roR Ii-3 0-os <br /> '-.=a �ytl.e :7at2 <br /> �rr RETURN PERMITS TO: <br /> MASTEFL.PS\FEES=L (6/00) PG&E <br /> JOB PROCESSING DESK -BLD 1 <br /> 4040 WEST LANE <br /> cTnr.KTnN CA 95204 <br />