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APPLICATION FOR ENCROACHMENT PERMIT <br /> PLEASE PRINT: <br /> Date rt <br /> OFFICE USE ONLY <br /> To: San Joaquin County JOB# <br /> Department of Public Works APN VY' REF# <br /> EXP. DATE Z <br /> CR# <br /> (Applicant Name) VALID To' DRIVEWAYS <br /> STREET <br /> AREA A4)q krr4eA QUAD­—,��-- <br /> TYPE <br /> (Mailing Address) FORMS <br /> NOTES <br /> (City,State,Zip Code) <br /> 71 <br /> (Area Code-Telephone Number) <br /> Sketch(Detailed plans may be submitted) _ <br /> 4e, <br /> The undersigned hereby applies for permission to excavate, construct and/or otherwise <br /> the eW-�77 side of rwise encroach on County Highway Right-of-Way on <br /> of-LC2��- approximately <br /> feet/mile <br /> by performing the following work(description of work).- <br /> Work will commence on or—about for approxi ately. <br /> m <br /> days. <br /> 1, 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 accqrqonce with the rules and regulations of San Joaquin County and subject to inspection and approval. <br /> Signature of Applicant Title Date <br /> — <br /> E IPOH-SV WKIMASTER PSIENCROACHMENT PERMIT APPLICATION DOC (01'08) <br />