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- Oji 3a�q ?©o-;)-- <br /> APPLICATIO24 FOR. ENCROP_CIDIENT PERMIT <br /> PLEASE PRINT: <br /> Dat? <br /> OFFICI USE ONLY'' <br /> '20 SGn Joaquin County T.., OD9d�� <br /> Jvt'� g REF Y. <br /> i Department of Public Works Ap <br /> j ..- N CR n <br /> P_ r, E S t 1L <br /> 1 � � VALID l 2 TO <br /> 1_9 <br /> DR. <br /> (Applicant Name) STREET' rV�QtWILL6 <br /> AD. <br /> 1<i 0-c-Ir a v- , :a c C �- QUAD _ Id E *. . <br /> FORMS S'S�1✓1.✓ <br /> V e53h© C NOTE <br /> (City, State, -Zip Code) <br /> (Area Code - Telephone Number) <br /> Sketch (Detailed.•plans 'maybe submitted) <br /> TRAFFIC CONTROL PLAN <br /> SHALL 8E AS PER <br /> CURRENT M.U.T.C.D. <br /> CALIFORNIA 5UPPLEMEN' <br /> The undersigned -hereby applies for permission to <br /> excavate, construct and/or <br /> of erwise encroach on Couaty Highway Right-of-Wa_i on, the • <br /> �L — ��X side <br /> �= approximately . <br /> of by performing <br /> following work . (description of work) <br /> Work will commence on or about - - for appro <br /> days: <br /> 'the undersigned certify that I am the owner of. the respective property, o <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 anal .s•ulhip_-t- t, <br />