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APPLICATION FOR ENCROACHMENT PERMIT <br /> PLEASE PRINT: <br /> Date '3 —4- OFFICE USE ONLY <br /> To: San Joaquin County JOB# 0065Z--& REF# <br /> Department of Public Works APN CR# <br /> EXP. DATE <br /> VALID .c7 TO .p� DRIVEWAYS: <br /> AG. &E. CO. STREET �criit' #\ _ <br /> 4040 WEST IANE AREA STU-4. QUAD GC <br /> TYPE —t'-CLL HOLE <br /> STOCKTON, CA 95204 FORMS , <br /> tec—r� SLft K%E'retz- NOTES <br /> (Area Code-Telephone Number) <br /> Sketch (Detailed plans may be submitted) <br /> Traffic Control Plan <br /> See attached sketch. Shall be as per <br /> PM 3 o Co'�) 5 -7 CA4- current M.U.T.C.D. <br /> Notif. ,Q 3-r 1 b ` California supplement. <br /> The undersigned hereby applies for permission to excavate,construct and/or otherwise encroach on County High Right-of-Way on <br /> the Se t STK side of�1cr� r,&&I A,4S . approximately 5 <br /> Of �it<�.J!�^t'� � ��-o PP y fe mile EosT- <br /> �-�to� by performing the following wok escription of work): <br /> Work will commence on or about e —'D—pg for approximately <br /> 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 /> us /1 1:>g 3-4- -(D5 <br /> Signature of Appli nt-Title <br /> Date <br /> 1EIPUBt-W.WKWASTER.PSIENCROACHMENIT PERMIT APPLICATION.DOC (01108) <br />