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PLEASE PRINT: APPLICATION FOR ENCROACHMENT PERMIT <br /> Date , <br /> To: San Joaquin County OFFICE USE ONLY <br /> Department of Public Works JOB# 7 �,�� _19 <br /> APN REF# <br /> � <br /> EXP.DATE CR#res' � --- <br /> (Applicant Name) VALID T p <br /> STREET �,;� DRIVEWAYS: <br /> AREA <br /> � - <br /> TYPE 5��--- QUAD <br /> (Mailing Address) FORMS PL14A�tE1C <br /> NOTES <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,construct and/or otherwise encroach on <br /> the �,.,3 side of '� <br /> °f approximate) County Highway Right-of-Way on <br /> b Y— <br /> y performing the following work(description of work): <br /> Work will commence on or about <br /> I,the undersigned,certify that I am the owner of the respective pro ert or for approximately <br /> days. <br /> R y, am for <br /> 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 subt <br /> subject ' <br /> ) o inspection and approval. <br /> amore of Applicant-Title _ Az <br /> EWU6-SVWKIMASTERPSIENCROACHMENTPERtaTAPPUICATION.DOC (01M) Date <br />