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APPLICATION FOR ENCROACHMENT PERMIT <br /> PLEASE PRINT: <br /> Date <br /> OFFICE USE ONLY <br /> To: San Joaquin County JOB# <br /> Department of Public Works REF# <br /> APN� <br /> EXP. DATE CR# <br /> VALID <br /> (Applicant Name) STREET j �T 7 u DRIVEWAYS: <br /> AREA QUAD <br /> TYPE <br /> (Mailing Address) i�Q1 U� <br /> FORMS <br /> �OCIiLLf= � (2A �j�Z j'7 NOTES <br /> (City, St te,Zip Code) <br /> (Area Code-Teleph ne Nufiiber) <br /> Sketch (Detailed plans may be submitted) <br /> The undersigned hereby applies for permission to excavate construct and/or otherwise en r h on County High Right-of-Way <br /> the side of C � � �` -���,Lylon <br /> approximately 1 � ee mile <br /> by performing the following work scription of work). <br /> �71- <br /> Work will commence on or about �, I <br /> 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 /> nature of Applicant-Title 1�� I <br /> E.IPII&SV WKIMASTERPSIENCROACHMENT PERMIT APPLICATION OCC (01108) Da <br />