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APPLICATION FOR ENCROACHMENT PERMIT <br /> PLEASE PRINT: <br /> Date 7 �. <br /> OFFICE USE ONLY <br /> To: San Joaquin County <br /> Department of Public Works JOB# 31. 2—�,� REF# <br /> APN CR# <br /> t C2 EXP.DATE _ p l <br /> VALID J > DRIVEWAYS: <br /> (Applicant Name) STREET _ <br /> '✓` �(1 r AREA Lft.UiJ QUAD ,G¢� <br /> +�-- TYPE <br /> (MailingiAddress) FORMS x <br /> NOTES — <br /> (City,State,Zip Code ' <br /> CO V <br /> (Area Code-Telephone Number) <br /> Sketch(Detailed plans may be submitted) <br /> PIVI <br /> L <br /> The undersigned hereby applies for permission to excavate, construct and/or otherwise encroach on County Highway Right-Of-Way <br /> the side ofE ,�; <br /> of approximately y on <br /> t, �{ �t pp oximately :J!/t, feet/mile_ AJ <br /> by performing the following work(description of work): <br /> Work will commence on or about , <br /> for approximately <br /> 1,the undersigned,certify that I am the own of the respective or am ____days. <br /> work described above in accordance with the rules and regulations of San Joaquin Cou to <br /> nds owner and agree to do the <br /> subject towner <br /> inspection and approval, <br /> g ature of Applicant-Title <br /> e:IPJ9-SV WI(VAASTER.PSIENCROACHMENT PERMIT APPLICATIONLOC /J5, 'Date <br /> t <br />