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PLEASE PRINT: APPLICATION FOR ENCROACHMENT PERMIT <br /> Date <br /> ' OFFICE USE ONLY <br /> To: San Joaquin County <br /> Department of Public Works JOB# PtyOCyII REF# <br /> APN CR# <br /> EXP.DATE <br /> VALID <br /> (Applicant Name) STREET -lam TO 0—11.t � DRIVEWAYS: <br /> AREA QUAD <br /> ( i g Address) TYPE <br /> 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 to excavate,construct and/or otherwise encroach <br /> of side of on County Highway Right-of-Way on <br /> approximately <br /> feet/mill <br /> e__________ <br /> by performing the followingwork(description of work): <br /> ------------ <br /> Work will commence on or about <br /> p <br /> proxima <br /> for ately <br /> I,the undersigned,certify that I am the owner of the respective property,or am qualified to re resen days. <br /> P t the owner and free to do the <br /> work described above in accordance with the rules and regulations of San Joaquin County and <br /> subject to <br /> f bi inspection and approval. <br /> Signature of App►' nt- itle <br /> E:VRB&SV WKVAMTERPMNCRppCH T RMR D e <br /> APPLICATION.pCC (07A8) <br />