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APPLICATION FOR ENCROACHMENT PERMIT <br /> PLEASE PRINT: <br /> Date --4-- 7-4— c>c OFFICE USE ONLY <br /> To: San Joaquin County JOB# fo REF# <br /> Department of Public Works APN CR# <br /> EXP. DATE <-•0 7 <br /> VALID TO -1 p DRIVEWAYS: <br /> A G. &E. CO. STREET ;Xy,� <br /> AREA _--VZe ,,y.4/QUAD <br /> 4040 WEST LANE TYPE <br /> STOCgTON, CA 95204 FORMS 9 ,. <br /> NOTES `- <br /> Zo9 - 9AZ - t53-7 <br /> (Area Code-Telephone Number) <br /> Sketch (Detailed plans may be submitted) <br /> Traffic Control Plan <br /> See attached sketch. Shall be as per <br /> PM 7--It:>-7 p -13 current M.U.T.C.D. <br /> Notif. l 0 31 04-ZZ California supplement. <br /> I <br /> 4 A ' t_u <br /> The undersigned hereby applies for permission to excavate construct and/or otherwise encroach on County Highway Right-of-Way on <br /> the =! l sideof,F�Ir-'C.G ,J Q�l� approximately a02 fe'tnile Kier.. <br /> of V'��'c� b"4 S Sita!.- , by performing the following wor escription of work): <br /> Qui cam, E'er 3 <br /> l N s c-�,— -- 4'�srr'�—� �" C�7'0'S�p �l t c..i �Aj in, /2" l�r� `PL <br /> �' 3d7Q�3�1 <br /> Work will commence on or about_ C -2 _o for approximately t4::) 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 /> work described above in accordance with the rules and regulations of San Joaquin County and subject to inspection and approval. <br /> Ac A <br /> Signature of Applicant-Title Date <br /> E1PU&SV.WRIMASTERPSENCROACHMEMPERMRAPPLICATION.DOC (01108) <br />