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APPLICATION FOR ENCROACHMENT PERMIT <br /> PLEASE PRINT: <br /> Date <br /> OFFICE USE ONLY <br /> To: San Joaquin County JOB <br /> Department of Public Works T <br /> F ? � REF#APN CR## <br /> EXP. DATE ;!/Cl <br /> A &E. CO. VALID .p To -/.�� _ DRIVEWAYS: <br /> STREET <br /> 4040 WEST LANE AREA Q <br /> STOCKTON. CA 95204 TYPEFORMS � MAKr <br /> NOTES <br /> (Area Code-Telephone Number) <br /> Sketch (Detailed plans may be submitted) <br /> See attached sketch. Traffic Control Plan <br /> PM Shall be as per <br /> current M.U.T.C.D. <br /> Notif. California supplement. <br /> I <br /> yJ!?/J. di J®/�'j y21? f 90 ✓ f7'�3 Ci 04 4,e-,k Weo <br /> `i�o.�,,rfs ��TT� y*2_`lz✓a ,��+�F� 4 c".or�'ia!' s�s,~t�'� y�/}.� <br /> .Gc✓'�i.[ Ci��.Tl!f.�r I�� 3 d���!�'C r '"'•" <br /> The undersigned hereby applies for permission to excavate, construct and/or otherwise encroach on Count <br /> the r, side of L <,, ,:.,. �,;: ;� Y Y Right-of-Way on <br /> ����' approximately r,=_.= <br /> of i-�,�� ,.� —�- PP Y feedmile <br /> by performing the following work(description of work): <br /> p—j .y./::;.`y""� 7 <br /> Work will commence on or about_ 'f,z, <br /> for approximately s t : days. <br /> I,the undersigned,certify that I am the owner of the respective property, <br /> work described above in accordance with the rules and regulations of an Jo qqu n ICoudnty andsubject o owner spect odn and ap rovahe <br /> P <br /> Signature of Applicant-Title <br /> Date <br /> clPU6-SV.WKIMASIEP PSiENCROACHMENT PaMIl APPLICATICN.DOI (71108) <br />