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APPLICATION FOR ENCROP_CMIEINIT PERMIT <br /> PLEASE PRINT: <br /> Late O OFFICE USE ONLY <br /> To: San Joaquin County JCH # 1 3 O rj Z- _ REF #--- <br /> De trent of Public Works aT)-N CR n <br /> EXP. DATE G I s 0 6 __ <br /> VALID t %,16 0 16 TO DRIVEWAYS. <br /> GA A <br /> (Applicant Name) STREET V e-P -- <br /> F.xFA S T X N_ _ QUAD !J E <br /> TYPE 1- — <br /> (Nailing Address) FORMS44r'� <br /> — _.-. --- --- --- NO'T'E <br /> - - 9:7 <br /> -- --, <br /> (City, tate, Zip Codex <br /> (Area Code -- Telephone Nisnber) -- <br /> Sketch (Detailed plans may be submitted) <br /> 3 7`l <br /> .bre l CO l e <br /> The undersigned hereby applies for permission to excavate, const ct and/or <br /> otherw's enc n <br /> ach on Couty Highway Right-of-Way onCthe side of <br /> ly _ feet/ <br /> approximate � <br /> of D by Pe forming he <br /> V <br /> following work (descri tion of work): <br /> � I <br /> Work will commence on or about • < i �� _� for approximately <br /> j — days' <br /> I, Lhe 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 /> approv 1 <br /> ,inspecta.on_ and <br /> vi =Ypl.i Cant - tic <br /> RETURN PERMITS TO: <br /> Kl TTR.PS\FEES=L (6/00) <br /> PGCE <br /> JOB PROCESSING DESK -BLD 1 <br /> 4040 WEST LANE <br />