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APPI,ICITION FOR ENCROACHMENT PERMIT <br /> PLEASE PRINT <br /> Date '.111L OFFICE IISS ONLY <br /> To: San Joaquin County JOB # 3.2 Z-CREF # <br /> Department of Public Works APN <br /> CR' # <br /> EXP. DAVE , <br /> PG VALID � • TO f•d g ]DRIVEWAYS: <br /> &E STREET Ic <br /> 4040 WEST LANE ARRA UAD - <br /> STOCKTON, CA 95204 NOTE <br /> OTE s <br /> (City, State, Zip Code) <br /> C2 -1761112- 1&27 <br /> (Area Code-- Tele-phone Number) <br /> Sketch (Detailed plans may be submitted) <br /> TRAFFIC CONTROL PLAN <br /> SHALL BE AS PER <br /> CURRENT,M.U.T.C.D. <br /> CALIFORNIA SUPPLEMENT <br /> SEE ATTACHEb SKETCH <br /> PM <br /> NOTIF: <br /> The undersigned hereby applies for permission to .excavate, cons ruct and/or <br /> otherw'se-encroacl3 on County Highway Right-of-Wa-y-on the <br /> . side of <br /> of approximately "_,,) feet/ms3't ,(j� , <br /> following_�ro_r ___,descrpton_ of_work) hY eriornting the. <br /> Work will commence on or about <br /> days. for approximately <br /> I, the undersigned certify that I am the owner of the respectiveproperty, 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 /> S ature of Applicant Title S <br /> Date <br /> MS=M.Ps\FsBs®z RETURN PERMITS TO: <br /> CCD <br /> PGAE <br /> P.O. BOX 930 <br /> STr)rk'Trnn► rA 0F9nl <br />