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, <br /> t APPLICATION FOR ENCROACI-IMENT PERMIT <br /> PLEASE PRINT: <br /> OFFICE USE ONLY <br /> Date '"------- - <br /> Jos '1'� O S 2 RBF <br /> To: San Joaquin County p-p — CR <br /> N ff <br /> Department of public works Epp DAT <br /> VALID <br /> (p o�0 �I DRIVEWAYS- <br /> C-Kt�I 6M6 ; . <br /> STREET �--- g� <br /> (Applicant Name) AREA�.�t� f QUAD <br /> TYPE E L L <br /> FORMS <br /> (Mailing Address) NOTE <br /> ,��r��? J <br /> (City, State, Zip Code) <br /> ------------- <br /> (Area Code - Telephone Number) <br /> i <br /> i <br /> Sketch (Detawled plans may be submitted) <br /> �514� <br /> a <br /> excavate, construct and/or <br /> lies for permission to ug, side of <br /> The undersigned hereby pp Highway Right-of-way on he ___ —_— <br /> otherwise� encr ach on County— approximately <br /> -— by Performing the <br /> of work) ' <br /> following work (d <br /> esof <br /> ( _0110 <br /> £or approximately <br /> Work will commence <br /> on or about — <br /> days <br /> ective Property, or am <br /> I <br /> the undersigned certify that I am thTeown�rd°oftheeworkpdescribed above in <br /> qualified to represent the owner <br /> lationsgof San Joaquin County and subject to <br /> accordance with the rules, regi <br /> inspection and approval. <br /> AoData <br /> Signata�, J,� nrYy <br /> RETURN PERMITS TO: <br /> p7elST�Z.PSI,FEESC50L W001 PG&E <br /> I <br /> ,JOB PROCESSING DESK -BLD 1 <br /> 4040 WEST LANE <br />