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APPLICATION FOR ENCROACHMENT PERMI C E I Y E D <br /> .. j r�eflf.5 <br /> PLEASE PRINT 2006 MAY <br /> i - <br /> Date ` ��./ OFFICE II5E ONLY <br /> To: San Joaquin County JOB # /��Z '�(�_ r <br /> -LaDartment of Public Works APN CR # <br /> EXP. DATE O 40 <br /> VALID Jr 2C 4a TO !o DRIVEWAYS: <br /> Applicant Name) <br /> STREET 1•A <br /> AREA 7-44 QUAD 514-2 <br /> TYPE —L�ELC.M7i,16-' T►QE — <br /> (Mailing Address) FORMS <br /> NOTE <br /> Zip Code) <br /> (Area Code - Telephone Number) <br /> Sketch (Detailed plans may be submitted) <br /> TRAFFIC CONTROL PLAN <br /> SHALL BE AS PER <br /> y!� CURRENT M.U.T.C.D. <br /> CALIFORNIA SUPPLEMENT <br /> The undersigned hereby applies for permission to excavate, const u t and/or <br /> otherwise er�roach on County Highway Right-of-Way on the — s ' e of <br /> ap roximatel feet/ ■ fziz <br /> of y perfprrrjLn5 the <br /> -A Arl <br /> llo ung - rk (descri«`�■r-� do of work) _ <br /> r <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 /> inspection and approval- <br /> Date Off - ��tl bats <br /> RETURN PERMR3 TO: <br /> MASTER.PS\FEES=L (6/00) <br /> PGM G' <br /> 40B P'ROMS)SMK3 DESK- BLD 1 <br /> 4M VVW UM <br /> S'TOCKTON,CA 9=4 <br />