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APPLICATION FOR ENCROACHMENT PERMIT <br /> PLEASE PRINT: <br /> Date <br /> OFFICE USE ONLY <br /> To: San Joaciyin County JOB# --AB1}e9<---- REF; <br /> DepartmE rit of Public Works APN CR# <br /> EXP.DATE <br /> VALID 0 DRIVEWAYS <br /> (Applicant Name) STREET <br /> AREA C QUAD 564-) <br /> 10 <br /> (Mailing Address) Fid <br /> NOTES <br /> (City,State,Zip Code) <br /> (Area Code-Telephone Number) <br /> Sketch(Detailed p ans may be submitted) <br /> The undersigned he.-eby applies for permission to excavate,construct and/or otherwise encroach on County Highway Right-of-Way on <br /> the side of -5� <br /> approximately <br /> Ile <br /> by performing the following work(description of work): <br /> zos <br /> W�r—kwill-aom-m­en-ct�-o—nor—about T� <br /> for approximately days. <br /> 1, the undersigned, ::ertify 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 /> Signature of Applicant 7fi—tle- <br /> Date <br />