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APPLICATION FOR ENCROACHMENT PERMIT <br /> PLEASE PRINT: <br /> Date OFFICE USE ONLY <br /> To: San Joaquin County <br /> Department ofPublic Works <br /> VALID io-f-as TO DRIVEWAYS: <br /> ( - <br /> AREA QUAD <br /> TYPE <br /> (Mailing A ess) FORMS <br /> NOTES <br /> (City,State, Zip Code) <br /> L <br /> (Area Code-Telephone Number) <br /> Sketch(Detailed plans may be submitted) <br /> The undersigned hereby applies for permission to excavate,construct and/or otherwise encroach on County Highway Right-of-Way on <br /> the sideof <br /> k st��-'N approximately "'feet/mile <br /> of by performing the following work(description of work): <br /> Work will commence on or about for approximately <br /> |.the undersigned, certify that| am the owner of the respective property, or am qualified to represent the owner and agree to do the <br /> work described abiaccordance with the | d regulations of San Joaquin County and subject to inspection and approval. <br /> Signatu Applicant-Title Date <br /> 4[' ' <br /> �B-SV WKWASTER P&ENCROACHMENT PERMIT APPLICATION DOG (OIJ08) <br />