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APPLICATION FOR ENCROACHMENT PER14MC E I V E.D <br /> PLEASE PRINT: <br /> 7006 MAY - I AM I 1: 25 <br /> Date <br /> uIff F.C�y"J,;3&d PRLYN o u K s <br /> To: San Joaquin County JOB a Vp5z- Y REF a <br /> Department of Pu,`_+lic Works ApN CR n <br /> EXP- DATE / <br /> VA-LID TO /dam DRIVEWAYS <br /> (Applicant Name) STREET <br /> AREA A QUP1D _ <br /> TYPE <br /> 71 (Mailing Address) FORMS <br /> �;(`— !z a;?-W NOTE <br /> (City, S a(tee,, Zip Code) ! <br /> (Ared Code .- Tele.ohone Number) <br /> Sketch (Detailed plans maybe submitted) <br /> TRAFFIC CONTROL PLAN <br /> SHALL BE AS PER <br /> CURRENT M.U.T.C.D. <br /> CALIFORNIA SUPPLEMENT <br /> L - <br /> Un t D t q8/7v8 <br /> The undersigned hereby applies for permission to excavate, qonstruct and/or <br /> otherwise encrcacI on Co mty Highway Right-of-Way on the side of <br /> approximatel feet/ <br /> of erf rming t e <br /> follo 'ng wor_ (description of work) : �Ih 4b <br /> Work will commence on or about for approximately <br /> days: . <br /> I, the undersigned certify that I am the owner of the. respective property, or am <br /> qualified to represent the owner and agree to do the work described above in <br /> accordance with the rules, regulations of San Joaquin County and subject to <br /> -- - ---._.-izrsp�i --$nc�-�pp-rev-al --- ------------..-. <br /> A411- <br /> sigmat-'=e Of Appiicamt - Title RETl1RNw�PwyE_�R�MITSTO: <br /> Date <br /> • G <br /> JOB PRMESSM DESK•BW 1 <br /> ` 40Q W w L" <br /> STOCKTON, CA 96204 <br />