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APPLICATION FOR ENCROACHMENTPERM[[ <br /> PLEASE PRINT: <br /> Dat* OFFICE USE ONLY <br /> To: San Joaquin County <br /> Department ofPublic Works <br /> EXP.DATE X,47 ow_ <br /> VALID TO DRIVEWAYS: <br /> (Applicant Name) <br /> AREA QUAD <br /> TYPE <br /> (Mailing Address) FORMS <br /> NOTES <br /> "/L <br /> (City'State,Zip Code) <br /> (Area Code'Telephone Number) <br /> Sketch(Detailed plans may be submitted) <br /> The updersignedh b applies for i ioto excavate, constructand/or otherwise o ach on County HihwayRight-of-VVavon <br /> the nidoof approximately OWmi|o_______ <br /> Of . . byperforming the following work(description Ofwmrk): <br /> Work will commenceon or about W mately <br /> for approxi days. <br /> |.the und8noi d certifyUhsk|am1hoowmnrofth8nmpnctivopmpehy. oromqua|ifindhampr9onnttheownerandogmo0»dotho <br /> work describe�above in accordance with the rules and regulations of San Joaquin County and subject to inspection and approval. <br /> Signature of Applicant-Title Date <br />