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APPLICATION FOR ENCROACHMENT PERMIT <br />PLEASE PRINT: <br />Date 2-2L1-lb <br />To:San Joaquin County <br />Department of Public Works <br />ex:....Co""'VV\.VV\'lCiA-+Il>~ <br />(Applicant Name) <br />2-"20'\t<o..v""evJx:-:stl""1m(Mailing Address) <br />Ell.<6Jcou'C.-,Co-q,~7L8 <br />(City,State,Zip Code) <br />OFFICE USE ONLY <br />JOB#1[000 >REF# <br />APN CR# <br />EXP,DATE 4-H6 <br />VALID 3-9-/6 TO 4"/-/G DRIVEWAYS: <br />STREET f.Wt!wood.. <br />AREA N1~61~QUAD t1;GtIJ1tE . <br />TYPE BoCf . <br />FORMS HWW R)}j <br />NOTES <br />({It,106 -'1I2lCD <br />(Area Code.Telephone Number) <br />Sketch (Detailed plans may be submitted) <br />Work will commence on or about-for approximately \days, <br />2-2.'-l -16 <br />DatefApplicant.Title <br />J <br />I,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 a ve in accordance with the rules and regulations of San Joaquin County and subject to inspection and approval.