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APPLICATION FOR ENCROACHMENT PERMIT <br /> PLEASE PRINT: <br /> OFFICE USE ONLY <br /> Date <br /> JOB g DE°2 (2-- REF 4 <br /> To : San Joaquin County PN cl� <br /> D r ent of Public Works EXP_ DA�T,,E <br /> VALID TO � DRIVEWAYS: <br /> QUAD <br /> tt Name) STREETttAREA STK�TYPE <br /> FORMSAddress) i NOTE <br /> (City, State, Zip Code) <br /> (Are Code - Tel <br /> Number) <br /> Sketch (Detailed plans may be submitted) TRAFFIC CONTROL.PLAN <br /> SHALL BE AS PER v o <br /> CURRENT M.U.T.C.D. i <br /> CALIFORNIA SUPPkMST OM <br /> Q' rn <br /> r' <br /> Q N <br /> CA <br /> ission to excavate, c stru t and/or <br /> The undersigned hereby applies for permsi of <br /> o t <br /> rwi e e croach on County Highway Right-of-W, on the � * <br /> � approximately <br /> by p rfoing the <br /> of - <br /> follow' g work dt cri t' n of work) : <br /> for approximately <br /> Work will commence on or about <br /> days: <br /> �the undersigned certify that I am the owner of the respective property, or am <br /> I <br /> agree to do th <br /> qualified to represent the owner and inwOo ndesabove <br /> n <br /> and subjectto <br /> accordance with the rules,, regulatio s of San Joaquin Y <br /> inspection n4 approval. <br /> Date <br /> .Sa.yL.avi t rir_f,_N".d e an t _ i��_ FE jRN PERMITS TO: <br /> ''..iirc <br /> P ^ <br /> MASTER.PS`.FEESC-EDL (a/aa) JM PROC�E&MG DESK-SM 1 <br /> 4N0~LAWN <br /> STOCKfON, CA 95204 <br />