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APPLICATION FOR ENCROACHMENT PERMIT <br /> PLEASE PRINT: <br /> Date 11/06/2012 <br /> OFFICE USE ONLY <br /> To: San Joaquin County <br /> Department of Public Works JOB# /DaOs REF# <br /> San Joaquin Regional Rail Commission APN CR# <br /> C/0 Bryan Pennino EXP.DATE e �Z <br /> VALID <br /> (Applicant Name) TO STREET , !� DRIVEWAYS: <br /> �. <br /> 949 E. Channel Street AREATYPE c,T`l QUADW. <br /> tis <br /> (Mailing Address) FORMS 2�* ! fG <br /> X�OD�i�!lgT� <br /> Stockton, CA. 95202 NOTES <br /> (City, State,Zip Code) <br /> 209-456-2063 <br /> (Area Code-Telephone Number) <br /> Sketch(Detailed plans may be submitted) <br /> See detailed plans. <br /> �OPL1Cs�/�1�S�Igd.,GWDiJV�� <br /> 4f1�iVf/®�G/g�Ai1V4S,,�/i®S1G.ugL � ✓PCiA*40941-y 4oIe Alzv� <br /> The undersigned hereby applies for permission to excavate, construct and/or otherwise encroach on County Highway Right-of-Way <br /> the side of <br /> of approximately on <br /> feet/mile <br /> Modification of Traffic Si nal a ui ment at the corner of E. Ai p erfonerAve thae following nd West work <br /> (description of work): <br /> Work will commence on or about 11/06/12 <br /> for approximately Ca en er <br /> I, the undersigned, certify that I am the owner of the respective property, or am qualified to represent the <br /> days. <br /> do <br /> work described above in accordance with the rules and regulations of San Joaquin County and subject to inspe ton and approval.the <br /> - Project Manager <br /> Signature of Applicant-Title 11/06/2012 <br /> Date <br /> E1PUB-SV.WKIWASTER.PSIENCROACHMENT PERMIT APPLICATIONAOC (01/08) <br />