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APPLICATION FOR ENCROACHMENT PERMIT <br /> PLEASE PRINT: <br /> Date <br /> OFFICE USE ONLY <br /> To: San Joaquin County JOB# REF# <br /> P <br /> Department of Public Works [APN CR# <br /> EXP. DATE <br /> E� VALID <br /> 6 6 IT DRIVEWAYS: <br /> (Applicant Name) STREET <br /> AREA IAI:6,49W QUAD <br /> O TYPE &-J-ve-bc <br /> (Mailing Address) FORMS <br /> NOTES <br /> (City,State, Zip Code) <br /> 4� <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 side of <br /> feeVmile7 <br /> of ZV16 Le�& <br /> approximately_.. <br /> by performing the following work(description of work): <br /> Work will commence on or about <br /> IU[ approximately <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-0 aperdance with the rules and regulations of San Joaquin County and subject to inspection and approval. <br /> Signature of Applicant-Title <br /> Date <br /> E TUB-SV WKIMASTER PSENCROACHMEUT PERMIT APPLICATION DOC (01108) <br />