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APPLICATION FOR ENCROACHMENT PERMIT <br /> PLEASE PRIh <br /> Date <br /> OFFICE USE ONLY <br /> To: San Joaquin County <br /> JOB# REF# <br /> Department of PublicWorks APN CR# <br /> EXP. DAT"E <br /> VALID TO DRIVEWAYS: <br /> (Applicant Name) STREET <br /> AREA <br /> OUAD <br /> TYPE <br /> (Mailing Address) FORMS <br /> jj NOTES <br /> (Citi,State,-Zip Code) <br /> (Area Code-Telephone�Number) <br /> Sketch(Detailed plans may be <br /> submitted) <br /> The undersigned hereby applies forRermission to excqyate,construct and/or otherwise encroach on County Highw Right-d*ayon <br /> the_42CUL_ side of approximately 7W <br /> of-91tA 13 <br /> -6 by Performing the b4ovAng work(description of work): <br /> Work will commence on or about <br /> tar approximately ___ 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 in accordance with the rules and regulations of San Joaquin County and subject to inspection and approval. <br /> ;T <br /> nature of Applicant. 410 Date <br />