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PLEASE PRINT: APPLICATION FOR ENCROACHMENT PERMIT <br /> Date <br /> To: Sal Joaquin county OFFICE USE ONLY <br /> Department of Public works JOB # # <br /> APN REF <br /> EXP. DATE CR' <br /> (Applicant Name) VALID le) T <br /> STREET DRIVEWAYS: <br /> AREA "5'- <br /> QUAD <br /> ( TYPE 6?�_ <br /> Mailing <br /> Address) FORMS <br /> NO, <br /> (City, State, ZiP Code) <br /> (Area Code Tele hone Num-ber) <br /> Sketch (Detailed Plans may be submitted) <br /> Sketch <br /> The undersigned hereby applies for <br /> Otherwise encroach permission to excavate, <br /> on County permission <br /> construct arid/or <br /> ht-of <br /> -W Right -Way on the <br /> of approximately side of <br /> 7-)k <br /> foil <br /> ---------------- �/mile <br /> by Performing the <br /> Owing work (description of work) 7-7- <br /> Wcrk will commence on or _,ablut <br /> days . f or -approximately <br /> undersign.edcer, <br /> -if'V that am the cf the respectile <br /> -e c ner and agree cc do -,he wcrk iescribed abo-.-e ir, <br /> -l""crdance witi., the I-Liles, reg,,-Ilat; Prcpertv, am <br /> "'sPection ard ol s 0`7 San J- a- Ccunty and sub , <br /> Ppro,,'al. j ec t <br /> 4 <br /> Sign <br /> sure of APPlicant - AJ5iL <br /> Title <br /> Date <br />