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APPLICATION FOR ENCROACHMENT PERMIT <br /> PLEASE PRINT: <br /> Date �• �+� • 0� OFFICE USE ONLY <br /> To: San Joaquin County JOS # 730 � LREF # <br /> Department of Public Works APN CRAL <br /> EXP. f <P <br /> VALI TO DRIVEWAYS: <br /> (Applicant Name) STREET <br /> 7-Z <br /> AREA STKA( QUA <br /> �G �ZAW TYPE L.( k01-4- :1-14?f-&3CA4 <br /> T (Mailing Address) FORMS <br /> 6�( 6i-p�1 , "C� IC f� NOTE.. <br /> (City, State, Zip Code) <br /> � Id2 - <br /> (Area Code - Telephone Number) <br /> Sketch (Detailed plans may be submitted) G' <br /> TRAFFIC CONTROL PLAN o c <br /> SHALL BE AS PER -ry r- >rr <br /> CURRENT M.U.T.C.D. c ; <br /> CALIFORNIA SUPPLEME�g_ <br /> OrT <br /> C> w c <br /> 7K <br /> 1 0 � 020 5 <br /> The undersigned hereby applies for permission to excavate, construct and/or <br /> othe wise encroach on County Highway Right-of-Way on the tad6!J7 side. of <br /> 't '� approximately feet/WwWa .150641-% <br /> of , by performing the <br /> followi g work (description of work) : <br /> Work 1 commence on or about for approximately <br /> T17— <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 /> 11410& <br /> :S3-, ature of Applicant - Title Date <br /> RETURNPERMITS TO: <br /> -P \FEESCHDL (6/00) • <br /> OM <br /> .109 PRMES$M DESK- BLD 1 <br /> 4040 Vftd Lana <br /> STOCKTON,CA 9604 <br />