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APPLICATION FOR ENCRfJA-^HMPERMIT <br /> PLEASE PRINT: ,•- ' <br /> Yi' <br /> Date q _ aq V I TOFFICE USE ONLY <br /> To: Sa n Joaquin Count JOB# �fl REF <br /> q y <br /> Department of Public Works APN CR# <br /> EXP.DATE <br /> • <br /> TO DRIVEWAYS: <br /> VALID. �'� <br /> (Applicant Name) 7. STREET <br /> i AREA e l QUAD <br /> TYPE <br /> r—(Mallin Ag <br /> (Mailing FORMS <br /> NOTES <br /> V C�YAG <br /> C-iN <br /> (City, State,Zip Code) <br /> 40q –_ +8 46—a <br /> (Area Code-Telephone Number) <br /> Sketch(Detailed pians may be submitted) <br /> The undersigned hereby appli for ermission to excavate,construct and/or otherwise encroach on County highway Right-of-Way on <br /> the side of i �i *pproxima#ely —feetlmile <br /> of e ,by performing thefolWing work(description of work): <br /> Work will commence on or about for approximately days. <br /> 1, 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 i cc rdance with the rules and regulations of San Joaquin County and subject to inspection and approval. <br /> Signat of Applicant-Title IDfff A <br /> VFOAMS&TEMPLATE —WNTPERRTAPPUCATiON:ddel") <br />