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APPLICATION FOR ENCROACHMENT PERMIT <br /> PLEASE PRINT: <br /> Date OFFICE USE ONLY <br /> To: San Joaquin County <br /> Department o/Public Works <br /> _ <br /> VALID 14o-Oq TO _to DRIVEWAYS: <br /> STREET <br /> (Applicant Name) <br /> (MaUAin Address) FORMS <br /> NOTES <br /> (City,State, Zip Code) <br /> (Area Code-Telephone Number) <br /> Sketch(Detailed plans may be submitted) <br /> The undersigned hereby applies for permission Uoexcavate,constructand/or otherwise <br /> the U c LLL_ side of I, approximately AL <br /> by performing the following work(description of work): <br /> -------' <br /> for approximately 'I- <br /> |. theunUermgned certuf� that |amthe owner ofthe respective property,uramqualified torepresent'he owner and agree UoiJnt'he <br /> womdescribed above inaccordance with the rules and regulations ofSan Joaquin Cmun�and nu�o�Voinopeohonand appnuva| <br /> l_ r <br /> Signature u/ Applicant' /me Du8o ^ --- <br />