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APPLICATION FOR ENCROACID ENT PERMIT <br /> PLEASE PRINT: <br /> /� � �� O � OFFICE USE ONLY <br /> Date 2 <br /> JOE {F 73REF <br /> To: San Joaquin County PIN CR it <br /> Department of Public Works Exp_ DAT l D <br /> y j�/` TQ DRIVEWAYS: <br /> / C7 _ VALID .. -VeA2 1414 <br /> (Applicant Name) STREET /1/�, <br /> /' � <br /> +�r�_ QUAD <br /> ARRA <br /> Z-, /Vz TYPE <br /> (Mailing Address) ii FORMS <br /> NOTE <br /> (City, State, tiip Code) <br /> _c2 14 <br /> ' ij,(Arq9a-Code, - Telephone Number) <br /> 18 keh tailed plans may be submitted) TRAFFIC CONTROL PLAN <br /> y "iz 7 SHALL BE AS PER <br /> Ln CD CURRENT M.U.T.C.D. <br /> Cz CL <br /> CALIFORNIA SUPPLEMENT <br /> /L�G��-� <br /> CL <br /> N w <br /> The undersigned hereby applies for permission to excavate, construct <br /> 00 t v anilide <br /> otherwise encroach on County Highway Right-of-Way on the T side of <br /> 14VE approximately o?o?7 feet/mile �U <br /> by performing the <br /> of S ';Vc=-r- ' <br /> following work (description of work) : _ t <br /> out <br /> Work will commence on or ab <br /> 02 0O 6 for approximately <br /> 42-D 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 /> X00 <br /> Data <br /> -f T_-1'ican tl N PERMITS.TO: <br /> si y��at::rs _rr _ RETURN <br /> ppSTER.PS',FEES(--E0L (G CIO) X* &S MSK-BLD 1 <br /> W <br /> STOCKTON, CA 9=4 <br />