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APPLICATION FOR ENCROACHMENT PERMIT <br /> pLSABE PRINT: <br /> Date OFFICE USE ONLY <br /> To: San Joaquin County JOB # REF # <br /> Department of Public Works APN CR # <br /> EXP. DATE <br /> VALID TO DRIVEWAYS: <br /> (Applicant Name) STREET <br /> AREA QUAD <br /> TYPE <br /> ( Sailing Address) FORMS <br /> NOTE <br /> (City, State, Zip Code) <br /> (Area Code - Telephone Number), <br /> Sketch, (Detailed plane may be submitted) <br /> The undersigned hereby applies for permission to .excavate, construct and/or <br /> otherwiseencroachon-County Highway Right-of-Way-on-the side-of <br /> approximately feet/mile <br /> of , by Vexformirig the <br /> following work (description of work) : <br /> Work will commence on or'about for approximately <br /> days. <br /> I, the undersigned certify that I am the owner of,the respective property, or am <br /> qualified to represent the owner and agree to do the work described above in <br /> accordance with the rules, regulations of San Joaquin County and subject to <br /> inspection and approval. <br /> Signature of Applicant Title Date <br /> KASTRR.PS%PH6S®L (6/00) <br />