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APPLICATION FOR ENCROACHMENT PERMIT <br /> PLEASE PRINT: <br /> Date `s OFFICE USE ONLY <br /> To: San Joaquin County JOB# Mj� o2-(n REF# <br /> Department of Public Works APN CR# <br /> EXP.DATE <br /> VALID 6.16.0 9 TO /p./,5-.057 DRIVEWAYS: <br /> A G. &E. CO. STREET <br /> 4040 WEST LANE AREA ,J6rz>/ QUAD Ale <br /> TYPE <br /> STOCKTON, CA 95204 FORMS S>F <br /> NOTES <br /> (Area Code-Telephone Number) <br /> Sketch (Detailed plans may be submitted) <br /> ';A Traffic Control Plan <br /> See attached sketch. Shall be as per <br /> PM c'7- current M.U.T.C.D. <br /> Notif.1,n `{ California supplement. <br /> The and rsigned hereby applies for permission to excavate construct and/or otherwise encroach on County Highway Right-o-Way on <br /> the l5 side of Anstt�5 1G.DA_approximately Z 344 feetlr s <br /> of L_®�, , by performing the following work(description of work): <br /> Edi <br /> Work will commence on or about e for approximately f 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 /> Ij <br /> Signature g re of Aplicant- itle Date <br /> EaPUB SV.WKWASTERPSIENCROACHMENT PERh!IT APPLICATICN.000 (07108) <br />