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APPLICATION FOR ENCROACHMENT PERMIT <br /> PLEASE PRINT: <br /> Date I` 46 •©`O OFFICE USE ONLY <br /> To : San Joaquin County JOB # .x/52–gyp REF # <br /> Department of Public Works APN CR # <br /> EXP. DATE 707 <br /> _ <br /> VALID S O!o TODRIVEWAYS: <br /> (Applicant Name) STREET j/y X1c <br /> AREA S_0c/Mn/ QUAD <br /> TYPE ��ELG NotE <br /> (Mailing Address) A FORMS <br /> C�> yn , � �Y NOTE —T <br /> (City, State, Zip Code) <br /> � 41AtZ <br /> (Area Code - Telephone Number) <br /> Sketch (Detailed plans may be submitted) <br /> TRAFFIC CONTROL PLAN <br /> SHALL BE AS PER <br /> CURRENT M.U.T.C.D. <br /> CALIFORNIA SUPPLEMEIT <br /> tr -i cr^ <br /> a Z< <br /> The undersigned hereby applies for C a <br /> g y pF permission to excavate, construct andr 00 <br /> otherwise encroach on County Highway Right-of-Way on the I4oP'4-1-t s e of <br /> �.wq ache approximately feet/m.-k23 <br /> of Q• ii kvG , , by performing the <br /> following work (de cription of work) : Mel I hn a* �- <br /> �D•P <br /> Work will commence on or about for approximately <br /> U5© 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 /> Rf ibf 62Si ature Applicant - Title Date <br /> /'yam,{J�y�•. .�'}'� <br /> MAST ..F \,FEESCHDL 6/0 0) r�� V To:JM PRME8,0&4G <br /> • �DESK _ <br /> 4W Wed LWO <br /> STOCKMN, CA9 \ <br />