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APPLICATION FOR ENCROACHMENT PERMIT <br /> PLEASE PRINT: <br /> Date MAte , �� T �pp`� OFFICE USE ONLY <br /> To: San Joaquin County JOB# rf 3oa5Z-G, REF# <br /> Department of Public Works APN _ _ CR# <br /> EXP. DATE - 1 S-0 <br /> VALID 4-)-i-Q I TO 17.t s ol? DRIVEWAYS: <br /> A G. &E. CO. STREET CA%eP*x37r-4 lft>, <br /> 4040 WEST LANE AREA S17&c,m,.! QUAD 5S <br /> TYPE IoG6 <br /> STOCKTON, CA 95204 FORMS <br /> NOTES <br /> Zai 94Z- i <br /> (Area Code-Telephone Number) <br /> Sketch(Detailed plans may be submitted) <br /> Std ATC4-NED � E" � Traffic Control Plan <br /> See attached sketch. Shall be as per <br /> PM 30"70 1*7 7 current M.U.T.C.D. <br /> Notif. c)a-7546IS California supplement. <br /> The undersigned hereby appliesfor permission to excavate,c nstruct and/or otherwise encroach on County Highway Right-of-Wayon <br /> the side of—! Q approximately !SOM _ feet/90 fiuff <br /> of � �z C.K _ by performing the following work(description of work): <br /> G;5 <br /> O -- <br /> Work will commence on about 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 cribed above in accordance with the rules and regulations of San Joaquin County and subject to inspection and approval. <br /> - A <br /> , <br /> Signature o Applicant-Title Date <br /> E:IPUB-SV.WKIMASTER.PSIENCROACHMENT PERMIT APPLICATION.DDC (OVOB) <br />