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t <br /> APPLICATION FOR ENCROACHMENT PERMIT <br /> PLEASE PRINT• <br /> - <br /> � <br /> Date r.' OFFICE USE ONLY- <br /> To: San Joaquin County JOB REF # <br /> Department of Public Works APN CR <br /> r" <br /> EXP. DATE 1-t-CJ q <br /> • --• + VALID 8-ig)-08 TO 't-i-09 DRIVEWAYS: <br /> (Applicant Name) STREET Live 54, kci. <br /> AREA fcQUAD _ <br /> TYPE, (L N o <br /> FORMS <br /> NOTE y F <br /> (Mailing Address) <br /> � NOTE <br /> t <br /> (City, St-ite, Zip Code) <br /> i <br /> (Area Code - Telephone Number)' <br /> Sketch (Detailed plans may be submitted) <br /> �- TRAFFIC CONTROL PLAN <br /> F°- SHALL BE AS PER <br /> CURRENT M U.T C.D. <br /> CALIFORNIA SUPPLEMENT <br /> ,t.. c=1 rte! <br /> The undersigned hereby applies for permission to .excavate, co struct and/or <br /> o'herwise e croac - n County Highway Right-of- & a-the 4=�L ra sid of <br /> tv ��� aroximately <br /> of PP, feet/� <br /> by performing the <br /> f901,310win work (deAcription of work) : <br /> At b� <br /> �D <br /> W®r �willommence on or about CF for approximately <br /> .>' <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 /> inspect' n and approval. <br /> Signature of Applicant - Title Date <br /> -STER.PS\FRES®L (6/00) <br />