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APPLICATION FOR ENCROACM1ENT PERMIT <br /> PLEASE PRINT: <br /> Date 0!ep f OS OFFICE USE ONLY <br /> To: San Joaquin_ County JOB # 730D5o�-'tin REF # <br /> Department of Public Works APN CR # <br /> EXP. DATE ''r•l�•O <br /> VALID [[� TO r�/S•09 DRIV&WAYS: <br /> STREET, <br /> AREA STK A] QUAD ,_ S <br /> 4040 WEST LANE TYPES o a — <br /> FORMS i4 Gtlltl, <br /> STOCKTON, CA 95204 NOTE <br /> (City, State, Zip Code) <br /> (Area Code Telenhone 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 SUPPLEMENT <br /> SEE ATTACHED SKETCH <br /> PMS°-25-�7 <br /> N01-IF: 10�50404 <br /> The undersigned hereby applies for permission to-excavate, nsitruct and/or <br /> oth i e- cro ch n County Highway Right-of-Way n the ... s'de.o <br /> XI _1approximatel feet/mom <br /> Of — Y}y -pe forming the <br /> ___.__�___ o1losnrin czrk (cl ption of work): bat ft UA <br /> Work will commence on or about for approximately <br /> I 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 /> tature o£ Anplicant - Title Date <br /> MASMM.ps\Fas®L (6/00) RETURN PERMITS TO: <br /> CCD <br /> P&&E <br /> P.O. BOX 930 \ <br /> STOCKTON CA 95201 <br />