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APPLICATION FOR ENCROACHMENT PERMIT <br /> PLEASE PRINT: <br /> Date �`� -'� ' '` <br /> OFFICE USE ONLY <br /> To: San Joaquin County JOB# ISO�Ortq- l( REF# <br /> Department ofPublic Works <br /> VALID 41dit to 5 15- it DRIVEWAYS: <br /> AREA QUAD <br /> TYPE <br /> (Mailing Address) FORMS <br /> NOTES <br /> (City, State, Zip Code) <br /> (Area Code-Telephone Number) <br /> Sketch (Detailed plans may be submitted) <br /> The undersigned hGn»bv appliesfox permission <br /> the side of approximately feet/mile <br /> of by performing the following work(descriptio�n—of—work). <br /> Work will commence on or about for approximately days. <br /> |.the undersigned, certify that|annthe owner[f the respective p0 �K <br /> p� Oro0qu8|ifiedborepreSontthe owner and agree h/d0the <br /> work described above in acc _the rules and regulations of San Joaquin County and subject bninspection and approval. <br /> � <br /> — l <br /> — z <br /> 7 <br /> ^6 <br />