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APPLICATION FOR ENCROACHMENT PERMIT <br /> PLEASE PRINT: <br /> Date OFFICE USE ONLY <br /> To: San Joaquin County <br /> Department ofPublic Works <br /> VALID Z1 .6 TO <br /> (Applicant Name) STREET <br /> AREA QUAD <br /> TYPE J?4A0JV144 <br /> (Maifing Address) FORMS <br /> NOTES <br /> (Area Code-Telephone Number) <br /> Sketch(Detailed plans may be submitted) <br /> The undersig ed hereby applies for permission to excavate,construct and/or otherwise encroach on County Highway Right-of-Way on <br /> the 4/ side of lVe k 41,7 app <br /> of i&4e by performing the following work(des * tion of work): <br /> Work vill commence on or about le, days, <br /> for approximately <br /> |.the undersigned,oortify that I am the owner of the respective property,or am qualified to represent the owner and agree to do t he <br /> work described above in accordance with the rules and regulations of San Joaquin County and subject to inspection and approval. <br />