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APPLICATION FOR RNCROACHMENT PERMIT <br /> PLEASE PRINT: <br /> Date -421'2-� ------------ <br /> OFFICE USE ONLY <br /> To: San Joaquin Country JOB # 7-2k)5 Z--ce REF ## <br /> Department of Public Works APN <br /> CY ## <br /> �- <br /> EXP. DATE 3-iS.=o6 <br /> VALID- -/,0-0'7' TO /'3-/5-oe DRIVEWAYS: <br /> (Applpic�antt: N�a�mey)) STREET <br /> �-i�f a '�arE �7�• <br /> -) t�07 VfM �[ AREA QUp,D <br /> TYPE 155kv-1/odE t eA4E <br /> (Mailing Address) FORMS _SSuij j22 <br /> NOTE � <br /> (City, Stage, Zip Code) <br /> (Area Code - Telepho a Number) <br /> Sketch (Detailed plans may be submitted) <br /> TRAFFIC CONTROL PLAN <br /> 5HALL;13E AS PEP, <br /> C CURRENT M.U.T.C.D. <br /> CALIFORNIA SUPPLEMENT <br /> ► �� <br /> The undersigned hereby applies for permission to.excavate, .c ns-t uct and/or <br /> otherwi. a-e crow - on CoLurty Highway Right-of-Way-on-the <br /> rside.:Of :.-. <br /> approximately 4- <br /> of f - feet/mile �a1� <br /> Af011&Owin work ( escription, of: work) : ` by P rformi the <br /> i <br /> Work will commence on or about <br /> days. for approximately <br /> I, the undersigned certify that I .am the owner of. the re spective, 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 /> tiare of Applicant Title <br /> nate <br /> nS®L (6/00) . <br /> i <br />