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APPLICATION FOR ENCROACHMENT PERMIT <br /> PLEASE PRINT: <br /> Date <br /> OFFICE USE ONLY <br /> To: San Joaquin County JOB# ' 3t��s g _rte, REF# <br /> Department of Public Works APN CR# <br /> EXP.DATE <br /> VALID !•Zt,.too TO �,�•, 9 DRIVEWAYS: <br /> A G. &E. CO. STREET L''#a'4,V76e ,Qp, <br /> 4040 WEST LANE AREA 5r i-eAy QUAD <br /> TYPE zlo� <br /> S'TOCKTON, CA 95204 FORMS <br /> NOTES <br /> 's <br /> (Area Code-Telephone Number) <br /> Sketch(Detailed plans may be submitted) <br /> Traffic Control Plan <br /> See attached sketch. j Shall be as per <br /> PM ' current M.U.T.C.D. <br /> Notif. 1 <br /> California supplement. <br /> The undersigned hereby appliespr permission to excavate,construct and/or otherwise encroach on Coun�Highway Right-of-Way on <br /> the �side of <— �Y�_' E.L _ pp y ° feay e s <br /> of approximately <br /> by performing the following work(description of work : <br /> F � <br /> P <br /> Work will commence on or about t� 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 /> wok described above in accordance with the rules and regulations of San Joaquin County and subject to inspection and approval.. <br /> f. I ' "" <br /> tr4 ( ._.,�s$ <br /> �. <br /> Signature df Applicant-Title `- <br /> Dat( <br /> EIPUB-SV.WKWASTER.PSIENCROACHMENTPMMITAPPLICATION.00C (01108) <br />