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APPLICATION FOR ENCROACHMENT PERMIT <br /> PLEASE PRINT: <br /> Date j `� �C OFFICE USE ONLY <br /> TO: San Joaquin County JOB # REF # <br /> Department of 'Public Works APN CR' # <br /> EXP. DATE C5 <br /> VALID TO DRIVEWAYS: <br /> (Applicant Name) STREET 69tQOr <br /> AREA QUAD �y�v <br /> Al E5 TYPE _ CL- <br /> (Mailing Address) FORMS <br /> C <br /> NOTE <br /> City, State, Zip Code) <br /> '74-Z- - t4-e2-_n__ <br /> (Area Code -_..Telephone_Number) •____ <br /> Sketch (Detailed plans may be submitted) TRAFFIC CONTROL PLAN <br /> SHALL BE AS PER <br /> CURRENT M.U.T.C.D. <br /> CALIFORNIA SUPPLEMEN'T- <br /> aa2 <br /> The undersigned hereby applies for permission to excavate, construct and/or <br /> otherwiseencroach on.County Highway Right-of-Way-oa-the :ow-- sd5� - <br /> approximately 23�� } feet <br /> of S. --Y.- , — C.` by -performing the <br /> following work (desc: i tion o work)_04 EQD <br /> SEL - l l <br /> Work will commence on or. about AIDE> for approximately <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 /> ins c ion and approval. <br /> MAC—o tot <br /> Signature of App icant - Title Date <br /> MASTER.PS\nESCEDL (6/00) <br /> 1\ <br />