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APPLICATION FOWNCROACHMENT PERMIT <br /> PLEASE PRINT: <br /> Date I'� �� OFFICE USE ONLY <br /> To: San Joaquin County JOB REF# <br /> Department of Public Works APN CR <br /> l _ EXP.-DATE d n -- <br /> i�101t✓ VALID TO Z./D /d DRIVEWAYS: <br /> (Applicant me) ' STREET t } <br /> AREA o QUAD A/E <br /> d Ox 2190 TYPE <br /> (Mailing Address) FORMS - 7 <br /> NOTES <br /> (City, State,Zip Code) <br /> (Area Code-Telephone Number) <br /> Sketch(Detailed plans may be submitted) <br /> "he undersigned hereby applies for permission to ex avate,construe and/or otherwise encroach on County Highway Right-of-Way on <br /> I e 4w side of _S;_ 1} e� approximately . 44" /mi!e h <br /> )f by performing the following work(description of work): <br /> 'York wil!commence on or about for approximately days, <br /> the undersigned, certify that I am the owner of the respective property,or am gpalified to represent the owner and agree to do the <br /> Bork described above in accordance with the rules and regulations of San Joaquin County and subject to inspection and approval. <br /> Signature plicant-Title Dat <br /> 'FGPoAS 3 TEMPLATEStDMA. ER.WT APPIICATIGNAGC 10&0Bi - <br />