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App _7ATION FOR ENCROACHIArT PERMIT <br />PLEASE PRINT: <br />Date <br />To: San Joaquin County Highway Department. <br />(Applicant Name) <br />(Mailing Address) <br />(City, State Zip Code) <br />(Area Codc - Telephone Number) <br />HCE USE ONLY <br />RED! <br />APN CRV# <br />EXP. DAII <br />VALID TO DRIVEWAYS:. <br />STREET <br />AREA QUAD <br />TYPE <br />FORMS <br />NOTE <br />JOB # <br />Sketch (Detailed plans may be submitted) <br />The undersigned hereby applies for permission to excavate, construct and I or otherwise encroach on County <br />Highway Right-of-Way on the side of approximately <br /> feet / mile of , , by performing the <br />following work: (description of work): <br />Work will commence on or about for approximately days. <br />I the undersigned certify that I am the owner of the respective property, or am qualified to represent the owner and <br />agree to do the work described above in accordance with the rules, regulations of San Joaquin County and subject <br />to inspection and approval. <br />SIGNATURE OF APPLICANT - IIILE DATE