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APPLICATION FOR ENCROACHMENT PERMIT <br /> PLEASE PRINT: <br /> Date &9 OFFICE USE ONLY <br /> To: San Joaquin County JOB# REF# <br /> Department of Public Works APN CR# <br /> EXP.DATE <br /> VALID 5 0 TO / a DRIVEWAYS: <br /> A O. &E. CO, STREET u4 t <br /> 4040 WAST LANE AREA -7jQUAD � <br /> TYPE a PILCJr <br /> STOCKTON, CA 95204 FORMS <br /> NOTES <br /> (Area Code-Telephone Number) <br /> Sketch(Detailed plans may be submitted) <br /> Traffic Control Plan <br /> See attached sket h. Shall be as per <br /> PM ,36,7//,<G. - current M.U.T.C.D. <br /> Notif./0 37Q06 ,�(�" California supplement. <br /> The undersigned hereby applies for permission to excavate,construct and/or otherwise encroach on County HighwayRight-of-Way on <br /> the l`i�C' r side of 0441/aC�A19 9' A approximately „�� ee �� <br /> of �;y✓I✓�G.. i4� by performing the following work escription of work): <br /> UN'L t -e— �o$gerox, -wed o.✓ 2;ALT- S L G , i✓� <br /> S !r0r 'z <br /> v <br /> Work will commence on or 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 /> work de cribed above in accordance with the rules and regulations of San Joaquin County and subject to inspection and approval.. <br /> �6�—Z" <br /> Signature of Applicant-Title <br /> 9 pp Date <br /> E:1PU8-SV.WRUAASTER.PSENCROACHMENr PERMIT APPLICATION-DOC (01/08) . <br />