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APPLICATION FOR ENCROACHMENT PERMIT <br /> PLEASE PRINT: <br /> Date <br /> OFFICE USE ONLY <br /> To: San Joaquin County <br /> Department ofPublic Works APN <br /> VALID TO DRIVEWAYS: <br /> (Applicant Name) STREET <br /> AREA QUAD <br /> TYPE <br /> (Maili Ag Addres s) FORMS <br /> NOTES <br /> (City,State,Zip Code) <br /> (Area Code-Telephone Number) <br /> Sketch (Detailed plans may be submitted) <br /> The undersigned <br /> pstruct and/or otherwise encroach on Count Hi h <br /> approximately fee ile 4-4,n <br /> the side of <br /> of 1100"1 <br /> rming the foll9wing work(description of work); <br /> by perf9 <br /> � <br /> Work will commence on or about <br /> for approximately <br /> |.the undersigned,certify that I am the owner of the respective property,or am qualified to represent the owner and agree to do the <br /> work described above in accordance with the rules and regulations of San Joaquin County and subject to inspection and approval, <br /> EIPUB SVWKIMASTERPSIENCROACHME�N74'.M�;','APPLIC;AT�OtJ DOC J01108) <br /> -- <br />