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APPLICATION FOR ENCROACHMENWAP��E JO Q ElQUI ��UHTv <br /> PLEASE PRINT: Zapf,JUL _7 AM r' 23 <br /> Date <br /> To: San Joaquin County JOB -- REF <br /> partment of Public Works A2N CR # <br /> EXP- DATE <br /> VALID OCp TO DRIVEWAYS: <br /> (A Name)t Name) STREET <br /> �( � / I /,J/) . <br /> AP.EA TI'd�� S2uAI� �_ <br /> 4 4 � . TYPE <br /> (Ma'iing Address) FORMS <br /> S� NOTE <br /> {city, State, Zip Code) <br /> C"� <br /> (Area Code - Telephone Number) <br /> Sketch (Detailed plans may be submitted) TRAFFIC CONTROL PLAN <br /> SHALL BE AS PER <br /> CURRENT M.U.T.C.D. <br /> CALIFORNIA SUPPLEMENT <br /> S� <br /> �N 3a Sl O `o S <br /> The undersigned hereby applies for permission to excavate, �construct and/or <br /> otherwi e, encroach on County Highway Right-of-Wa-y, on the JL4 _ side of/ <br /> A- approximate ��f �� feet/� Fzna ""' <br /> of ( by p rform g the <br /> following -wo� _ ( escription of work) : <br /> v LC�Ci C1. <br /> 41 <br /> 377 I 1 z5.73b <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 /> f A, ii `itle RETURN PERMITS.TO: atm <br /> Sigilatnra �,� rp - cant - <br /> MR.STER.PS',,FEESMML (6/00) <br /> �oe PROCESSM oESK-BW 1 <br /> 4W~Lana <br /> STOcKMN, CA moa <br />