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PLEASE PRINT: <br />Date <br />APPLICATION FOR ENCROACHMENT PERMIT <br />To: San Joaquin County <br />Department of Public Works <br />(Applicant Name) <br />(City, State, Zip <br />Area Code - <br />Number) <br />(Email Address) <br />OFFICE USE ONLY <br />JOB # REF # <br />APN CR # <br />EXP. DATE <br />VALID TO DRIVEWAYS: <br />STREET <br />AREA QUAD <br />TYPE <br />FORMS <br />NOTES <br />The undersig ed hereby applies for permission to excavate, construct and/or otherwise encroach on County Highway Right -of -Way on <br />the � S� side of Jz� approximately � / � Ce�t/mile �,_ <br />of oby performing the following work (description of work); <br />Work will commence on orafter -1 — for approximately days. <br />I, the undersigned, certify th the owner of the spective property, or am qualified to represent the owner and agree to do the <br />work described above ' ccordance with the r nd regulations of San Joaquin County and subject to inspection and approval. <br />Applicant -Title <br />Y:IFORMS & TEMPIATESIENCROACHMENT PERMIT APPLICATION.doc (OSIOS) <br />� Date <br />