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72 6` <br /> APPLICATION FOR ENCROP_CI-RIENT PERMIT <br /> PLEASE PRINT_ <br /> Date (��l.b/ 1 I OFFICE. SH' O*TL'_ <br /> To San Joaquin County <br /> ;oR 73 REF <br /> Department of Fuv?tic Works CR <br /> / \ EXP_ DATE o / /Z <br /> ✓Dkr�lIVzI.,ES l F�rz �G�FiJ VALID /r 2 To / z DRIVEWAYS_ <br /> (Applicant: Name) STREET tiJFST'�/I�ly✓/Q <br /> cGrr �� ;7 AREA /ISO QUAD *. <br /> �iJ ls+rG�ltiq� Si-L, TSE �L /1? <br /> tGEln� s <br /> (Mail i P_ddres s) FOAMS L✓W. 107 <br /> NOTE <br /> c.ONGo�e v7/ CA <br /> (City, State, Zip Code) <br /> (?,25).270 -22 79 <br /> (Asea Code - Telephone N=ber) <br /> Sketch (Detailed plans may'be submitted) TRAFFIC CONTROL PLAN <br /> SES ��Cc.v�7 � CoN S`r,�zuG?�O[v SHALL BE AS PER <br /> CURRENT M.U.T.C.D. <br /> f SKU7c-1f. CALIFORNIA SUPPLEMENT <br /> I - <br /> The undersigned hereby applies for permission to excavate, Aconstruct and/or <br /> Ot7.E2�_se encroach on County Highway Ri ght-of-Wa-i on the ./yUglw side of <br /> /SON tom. approximately 1 3G�0 fee /mile <br /> o= br performing the <br /> follcwi�ig work (description of work) : �k AV re : Y 30p fT 70 �i1�STAL[ - <br /> �ti�-zui2R.vS Fele S a-teyi c[-;S' - <br /> rope .4ODeT/Oiy AL �iUFO Cotir7AC7 � ECY .14AN A` 6M <br /> TAN OGHny.• (ZOQ) ZIV2 160 <br /> Work will commence on or about 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 ru7:es., regulatioris of Sa.n. Joaquin .County and .subject to <br /> inspection and approval: <br /> C7AS .�5�'i��ft-7oi2 <br /> -ate <br /> RETURN PERUffS TO: <br /> rrsrr�.es',FEEScn*. !F/cal JOS 7SM DESK-BLD <br /> i <br /> 4040 W86t <br /> fWW <br /> SpOi / A <br />