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APPLICATION FOR ENCROACHMENT PERMIT <br /> PLEASE PRINT= <br /> Date 9" 9 rL/!O OFFICE USE ONLY <br /> To: San Joaquin County JOB g 7 ✓2-G REF <br /> Department of Public Works PpN CR n <br /> EXP. DATE L <br /> VALID -'O�.TO 11101 DRIVEWAYS <br /> (Applicant Name) STREET <br /> AREA -J4 k-d QUAD 5S <br /> 410'10 Lk. V /-A/. TYPE -1-969�CJNG <br /> (Failing Address) FORMS g!, � IQ 1�9 <br /> NOTE <br /> .S72,-1Gll7ZQAJ eW 9,520 A/ - <br /> (City, State, Zip Code) i <br /> _ ) 9412 -/yq8 <br /> (Area Code - Telephone Number) <br /> Sketch (Detailed plans may be submitted) <br /> Pln 3050/7YS <br /> The undersigned hereby applies for permission to excavate, construct and/or <br /> otherwise encroach on County Highway Right-of-Way on the BOTH sideSof <br /> /3E/GH1-E .ST fok approximately /`'/D feet/a&--i�� .SDUTN <br /> of TN/RTCEA/Ti-/ .S'7: cT/CAMDAZ by performing the <br /> following work (description of work) : <br /> 1N .67-191.L Z:Ag C.4r31.0 TL/ 59T'!eS aY <br /> Work will commence 91 on or about '.2S'D I= for approximately <br /> 9� 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 /> J✓. - EST/IYI�ITDIL - 9 06 <br /> t ire of A- 1 - .itle Date <br /> �r ` RETURN PERMITS TO: <br /> MPSTER.PS',.FEESC(DL (6/00) 1 PGM <br /> JOB PROCESSI W DESK- BLD 1 <br /> 4040 Wye!LAM <br /> STOCKTON, CA 96204 <br />