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APPLICATION FOR ENCROACHMENT PERMIT <br /> PLEASE PRINT. <br /> Date <br /> OFFICE USE ONLY <br /> To: San Joaquin County JOB# f REF# <br /> Department of Public Works APN CR# <br /> EXP.DATE I ?l <br /> VALID TO ( tl DRIVEWAYS: <br /> (Applicant Name) STREET t <br /> r'— ; AREA �,QUAD <br /> /���P � �/� TYPE CqAl tit Lt <br /> (Mailing <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 hereby applies for permission to excavate,construct and/or otherwise encroach on County Highway Rtht-of-Way on <br /> the i side of <br /> of approximately fee <br /> by performing the following work(description of work): <br /> Work will commence onor about /. – ;, for approximately <br /> days. <br /> I,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 /> of A�fl - <br /> Signaturetle ` <br /> % Date <br /> E:%PUB-SV.WKUNSTER.PSENCROACHMENT PERMIT APPACATION.DOC (07%08) <br />