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APPLICATION FOR ENCROACHMENT PERMIT <br /> PLEASE PRINT: <br /> Date �1` ,rg,'f° Z t ` <br /> OFFICE USE ONLY <br /> To: San Joaquin County JOB# �3�5`z- 'ad. REF# _ <br /> Department of Public Works APN CR# <br /> EXP. DATE /( G <br /> VALID s o TOflT DRIVEWAYS: <br /> A G. &E. CO. STREET 4?^JC-QL„1 r2r, - <br /> 4040 WEST LANE AREA s---o c*--m,j QUAD <br /> TYPE <br /> STOCKTON, CA 95204 FORMS <br /> NOTES <br /> it 4 z <br /> (Area Code-Telephone Number) - <br /> MPM <br /> ed plans may be submitted) <br /> Traffic Control Plan <br /> ached sketch. Shall be as per <br /> �� � current M.U.T.C.D. <br /> Notif. , --� ICalifornia supplement. <br /> I <br /> The undersigned hereby applies l or permission to excavate, construct and/or otherwise encroach on County Highway Right f ay on <br /> the Ste " side of q�. - <br /> of 1l1 : approximately feei/aiie_ " <br /> I!S , by performing the following work(description of work): <br /> .. I <br /> WA-IM <br /> Work will commence on or about t� <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 /> work-described above in accordance with the rules and regulations of San Joaquin County and subject to inspection and approval.. <br /> Signature of Applicant•Title -MAX <br /> Qate <br /> EIPUB'SV.WRIMASLERPSENCROACHMERM PERMR APPLICARON.000 (01/09) <br />