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APPLICATION FOR ENCROACHMENT PERMIT <br /> PLEASE PRINT: <br /> Date OFFICE USE ONLY <br /> To: San Joaquin County JOB# 5-2—(o REF# <br /> Department of Public Works APN CR# <br /> EXP.DATE •%• U <br /> VALID Ll1•G TO •O DRIVEWAYS: <br /> AG. &E. CO. STREET 01Lktizzl2 <br /> 4040 WEST LANE AREA slacj , QUAD -re5 <br /> TYPE <br /> STOCKTON, CA 95204 FORMS S�syn <br /> NOTES <br /> �(ArCode-Telephone Number) <br /> Sketch(Detailed plans may be submitted) <br /> Traffic Control Plan <br /> See attached sketch. Shall be as per <br /> PMa`�C, IrfL?__ current M.U.T.C.D. <br /> Notif. � —?a _ California supplement. <br /> • <br /> The un ersigned hereby applies for permission to excavate,con uct and/or otherwise encroa h on Cy Highway Right-of-Way on <br /> the side of approximately feetES"' <br /> st <br /> of L tG-�1k1gr <br /> .� '� IC ZZ-7 7 by performing the following work(description of work): <br /> Work will commence on or about ( _ <br /> 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 /> w,9a-described above in accordance with the rules and regulations of San Joaquin County and subject to inspection and approval.. <br /> Signature of Applicant-Title ` ' <br /> Date <br /> EIPU8'SV.WKIMASTER.PSIENCROACKMENT PERMIT APPLICATION.DCC (01/06) <br />