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APPLICATION FOR ENCROACHMENT PERMIT <br /> PLEASE PRINT: <br /> Date ( 1j Cj OFFICE USE ONLY <br /> To: San Joaquin County JOB# 1100®5— REF# <br /> Department of Public Works APN CR# <br /> EXP. DATE 1.1.047 <br /> VALID (�,.)•o$ TO �.(.p� DRIVEWAYS: <br /> (Applicant Name) STREET �ST ;e'v. <br /> !° AREA '''n�9G4f QUAD <br /> -)'3 <br /> �` TYPE I/e=4, e! Qla4 Wx4tr <br /> (Mailing Address) FORMS ..--m--- <br /> NOTES <br /> (City','State, Zip Code) <br /> (Area Code-Telephone Number) <br /> Sketch (Detailed plans may be submitted) <br /> The under igned hereby applies for permissio.0 to excavate, construct and/or otherwise encroach on County Highwa Right-of-Way on <br /> the �� � _side of R('90 approximately. 00 feet/ ile <br /> of by performing the followiniwrk,�dd, cription of work): <br /> �; <br /> Work will commence on or about " -` for approximately (� days. <br /> I,the undersigned, certify that I am the owner of the respective property,or am qualified to represent the owner and agree to do the <br /> work described above in accordance with the rules and regulations of San Joaquin County and subject to inspection and approval. <br /> Signatu`e of Applicant-Title , Date <br /> c.WU&SV WKIMASTER PSIENCROACHMENT PERMIT APPLICATION)OC (01/08) <br />