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APPLICATION FOR ENCROACHMENT PERMIT <br /> PLEASE PRINT: <br /> Date --MAO- . OFFICE USE ONLY <br /> To: San Joaquin County JOB# 73ac jZ(� REF# <br /> Department of Public Works APN CR# <br /> EXP.DATE ?, t 5'•oci <br /> VALID •i3•o TO DRIVEWAYS: <br /> A G. &E. CO. STREET e-A#'FLzAYrC-r2 4D. <br /> 4040 WEST LANE AREA QUAD S! <br /> TYPE kcsL,E <br /> STOCKTON, CA 95204 FORMS _ • ��, �=Z�j' -- <br /> NOTES �— <br /> ���� X4-2 A--7 <br /> (Area Code-Telephone Number) <br /> Sketch(Detailed plans may be submitted) <br /> SlEE A��AiFO �57KETL -.-5 Traffic Control Plan <br /> See attached sketch. Shall be as per <br /> PM 30-10 1 64c)Co current M.U.T.C.D. <br /> Notif. 1031 *510 California supplement. <br /> The undersigned hereby applies for ermission to excavate, struct and/or otherwise encroac on Clot ty Highway Right-of-Way on <br /> the side of _ l �_approximately feetkle <br /> of by performing the following work(description of work): <br /> E U L <br /> AJ EE. FA <br /> P p <br /> Work will commence on or about Az7PAAGAO for approximately 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 /> wor abed above in accordance with the rules and regulations of San Joaquin County and subject to inspection and approval., <br /> Si nture of A licant-Ti .- a <br /> 9app tle Date <br /> EAPOB-W.WKIMASTER.PSIENCROACHMENT PERMIT APPLICATION-DOC (07108) <br />