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APPLICATION FOR ENCROACHMENT PERMIT <br /> PLEASE PRINT• <br /> Date l� '�� OFFICE USE ONLY <br /> To: San Joaquin County JOB EF # <br /> Department of Public Works APN CR # <br /> L_ I <br /> EXP. ,DATE 2 <br /> f6954F' fir" VALID 0<0 O C? Bp DRIVEWAYS: <br /> (Applicant Name) STREET ekmoru Ad. * <br /> A'^A^ AREA FJUsk(i CAXPQUAD :56 , <br /> • 4.040 AtaSl M0 TYPE 'aEGL AWA T�IB�`AkN} X660 <br /> (Mailing Address) w� FORMS <br /> NOTE- <br /> on , . 61 _ <br /> (City, State, Zip Code) <br /> 41A2i�2`� <br /> (Area Code - Telephone Number) <br /> Sketch (Detailed plans may be submitted) <br /> TRAFFIC CONTROL PLAN j <br /> SHALL BE AS PER <br /> ` � ►� CURRENT M.U.T.C.D. <br /> CALIFORNIA SUPPLEMENT <br /> 1 Io � IQ 1 � Flo <br /> The undersigned hereby applies for permission to excavate, nstruct and/or <br /> of erwise encroach on County Highway Right-of-Wa on the oside of <br /> An approximately feet/ml-1c: 6SA1 <br /> of by performing the <br /> 11i <br /> following !work ( sc i.ption of work) <br /> -�� use ��.��Y . ------ -----__._-_---------------------------------_� <br /> Work w'L.11 commence on or about .p 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 /> adw l bs C �266r I d s Z26 <br /> Si ature of Applicant - Title Date <br /> \\\\\\ <br /> MAST .P \FEEECHPL (6/00) RETURN PERMRS TO: <br /> JOB PROCESSMKi DESK BLD 1 <br /> 4040 <br /> STOOCrON, CA <br />