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APPLICATION FOR ENCROACHMENT PERMIT <br /> PLEASE PRINT: <br /> To: San Joaquin County J'0 6 <br /> Department of Public Works APN CR# <br /> VALID 1.411,011 r T6 DRIVEWAYS: <br /> (Applicant Name) STREET Nzz'e <br /> (Mailing Address) <br /> NOTES <br /> (City, State, Zip Code) <br /> (Area Code-Telephone NLvmber) <br /> Sketch(Detailed plans may oe submitted) <br /> The undersigned hereby applies for permission 0excavate,construct and!orotherwise enc08ch(n CounmHigh�@ Right-of-Way On <br /> dm <br /> side of - ' ~ -' <br /> appnoon��� feollmUe <br /> of <br /> by performing the following work(desicdption ofwork): <br /> .1—s— for approxill lately C", days. <br /> |. the undersigned, certify that ia0the owner Ofthe respective property,Vranlqualified tVrepresent the owner and agree k)dOthe <br /> work described above in accordance with the rules and regulations of San Joaquin County and subject to inspection and approval. <br />