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APPLICATION FOR ENCROACHMENT PERMIT <br /> PLEASE PRINT; <br /> Date OFFICE USE ONi_y <br /> To San Joaquin County JOB# '7 REF# <br /> --- — —� <br /> Department of Public Works ` APN _ CR <br /> EXP DATE <br /> - <br /> VALID _p -- TO DRIVEWAYS. <br /> (Applicant Name) STREET ._....1'•. - _ -- <br /> AREA c� -- QUAD <br /> TYPE , <br /> . <br /> (Mailing Address) FORMS , <br /> NOTES <br /> (City, State, Zip Code) <br /> i <br /> (Area Code-Telephone Number) <br /> Sketch (Detailec owns may be su muted) <br /> �i <br /> i <br /> I I <br /> I <br /> The undersigned hereby applies for permission to excavate, construct and/or otherwise encroach on County Highway Right-of-Way on <br /> the - _ side of---- .�-------=— -- approximately <br /> _feet/mileof by performing the following work (description of work): <br /> Work will commence c)n or aoout _ for approx mately _days. <br /> the undersignec. c;er?ify that I am -.he owner of the respective property or am qualified tc epresent the owner and agree to do the <br /> work described above in accordance with the rules and regulations of San Joaquin Cour•ty and subject to Inspection and approval. <br /> Sig ature of Applicant - Titie Date <br />