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APPLICATION FOR ENCROACHMENT PERMIT <br /> PLEASE PRINT: <br /> ``tt <br /> Date 9�f /�/ OFFICE USE ONLY <br /> To: San Joaquin County JOB# ;3j REF# <br /> Department of Public Works APN CR# <br /> EXP.DATE / !/ <br /> VALID // TO rJ / / DRIVEWAYS: <br /> A G. &E. CO. STREET w 5�}c,:2,d ELxz) AV. <br /> ' 1J/ <br /> 4040 WEST LANE AREA QUAD <br /> AleG, S <br /> STOCKTON, CA 95204 FORMS �s wuJ <br /> NOTES <br /> ACCu,-,J s=zN 3'2-Y- y7 <br /> (Area Code-Telephone Number) <br /> Sketch(Detailed plans may be submitted) <br /> I <br /> Traffic Control Plan <br /> See attached sketch. Shall be as per <br /> PM 3 o 7 ct3 vz / current M.U.T.C.D. <br /> Notif. C v 1/ California supplement. <br /> r`�>c rSL &A C 2/O-r1 amt (24 <br /> The undersigned hereby applies for permission to excavate,construct and/or otherwise encroach on County Highway Right-of-Way on <br /> the side of approximately_ L 2c v` feet/mile <br /> =E("�--T ;;,—L L C tz'o -F-Z' I-,741F by performing the following work(description of work): <br /> 7 Pt"c� <br /> iLQWLQ-C-NL fJc��S� ij� Lam-(2Lr 1% PeLc 0e <br /> PCV CL <br /> Work will commence on or about 'C/6(! I for approximately 4i v 1—azie,,r-JL days. <br /> I,the undersigned,certify that I am the owner of the respective property,or am qualified to represent the owner and agree to do the <br /> work described above in accordance with the rules and regulations of San Joaquin County and subject to inspection and approval.. <br /> Signature of Applicant-Title Date <br /> EfPUE-W.WKWASTER.PSIENCROACHMENT PERMIT APPLICATION.DOC (01108) <br />