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APPLICATION.FOR ENCROACHMENT PERMIT <br /> PLEASE PRINT: <br /> Date ���`� OFFICE USE ONLY <br /> To: San Joaquin County JOB# �) f!_ ' REF# <br /> Department of Public Works APN CR# <br /> /I � EXP.DATE ( (-I_/ <br /> 7� //l/&�l VALID. -( ¢ TO _( ! -1 - f DRIVEWAYS: <br /> (Applicant Name) STREET . r, <br /> AREA 'T"m"a/ QUAD <br /> TYPE T- rsf <br /> (Mailing Address) FORMSlf / <br /> e / ���s y NOTES <br /> (City, State, Zip Code) <br /> s7cq• —362 <br /> (Area Code-Telephone Number) <br /> Sketch (Detailed plans may be submitted) <br /> s� <br /> 2z- <br /> The <br /> - <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 feet/mile <br /> of by performing the following work(description of work): <br /> Work will commence on or about -7 ;;;Ile--Ifor approximately days. <br /> I,the undersigned,ce ' that I am the owner of the respective property,or am qualified to represent the owner and agree to do the <br /> work de ribe abo in accordance with the rules and regulations of San Joaquin County and subject to inspection and approval, <br /> re of Applicant-Title Date <br /> hI10E1lfRALSERVICESICLERICALIPUSSV'NKIMASTER PSIENCROACHMENTPERMIT APPLICATION DOC )09!13) <br />