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APPLICATION FOR <br /> PLEASE PRINT: <br /> Date ? OFFICE USE ONLY <br /> To: San Joaquin County <br /> Depa�mantofPu��VVodm �— '' <br /> � EXP DATE <br /> VALID TO DRIVEWAYS: <br /> (Applicant Name) STREET <br /> AREA 7*4eAe7v QUAD <br /> (Mailing Address) FORMS <br /> / <br /> mmEu ' <br /> (City, State, Zip Code) <br /> (Area Code-Telephone Number) <br /> Sketch (Detailed plans may be submitted) <br /> The undersigned hereby applies for permission to excavate,cons-5Wt and/o otherwise encroach on County Hi h Ri h t f�YV <br /> the <br /> by performing the following work(description of work): <br /> k®rk'Will Fcomme'nce on r for—approximately <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 accordance with the rules and regulations of San Joaquin County and subject to inspection and approval, <br /> Signature of Applicarif Title <br /> Date <br /> / <br /> " PEPM.=mCAI�^�C (0-8) <br />