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APPLICATION FOR ENCROACHMENT PERMIT <br /> 'LEASE PRINT: <br /> Date October 16, 2012 OFFICE USE ONLY <br /> To: San Joaquin County JOB# °? cis REF# <br /> Department of Public Works APN w CR# <br /> EXP. DATE <br /> KNIFE RIVER CONSTRUCTION VALID _ T DRIVEWAYS: <br /> (Applicant Name STREET & <br /> AREAj QUAD �f <br /> 655 W.CLAY ST. TYPE <br /> (Mailing Address) FORMS <br /> NOTES <br /> STOCKTON,CA 95206 <br /> (City,State,Zip Code) <br /> 209-948-0302 <br /> (Area Code-Telephone Number) <br /> Sketch (Detailed plans may be submitted) <br /> WORK BEING PERFORMED FOR TRACY MATERIAL RECOVERY&SOLID WASTE TRANSFER,30703 S. MACARTHUR DR., <br /> TRACY, CA 95337. IMPROVEMENT PLANS HAVE BEEN SUBMITTED BY OWNER. KNIFE RIVER CONSTRUCTION WILL BE <br /> PERFORMING THE WORK. <br /> ATTACHED IS THE TRAFFIC CONTROL PLAN FOR OUR WORK. <br /> The undersigned hereby applies for permission to excavate,construct and/or otherwise encroach on County Highway Ri ht-of-Way on <br /> the .� `" side of '�1�' Xie' Y <br /> approximate) / —f ile�° <br /> of . , by performing the following work(descnpion of work): <br /> Work will commence on or about OCTOBER 29TH, 2012 for approximately 30 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 /> ignature of Applicant-Title Date <br /> YAFORMS&TEMPLATESIENCROACHMENT PERMIT APPLICATIONADc(08/08) <br />