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APPLICATION FOR ENCROACHMENT PERMIT <br /> PLEASE PRINT:: ° <br /> Date10102 OFFICE USE ONLY <br /> To: San Joaquin County JOB# 3oaS" Z - REF# _ <br /> Department of Public Works APN CR# <br /> EXP. DATE /a.r.a 9 <br /> VALID • 15--ip j TO DRIVEWAYS: <br /> AG. &E. CO. STREET <br /> 4040 WEST LANE AREA 2i2z)r QUAD ,yw <br /> STOCKTON, CA 95204 FORMS <br /> NOTES <br /> �zaq 99e ;7- - l s';!24 <br /> (Area Code-Telephone Number) <br /> Sketch (Detailed plans may submitted) <br /> Traffic Control Plan <br /> See attached sketch. Shall be as per <br /> PM 4 jQ(p 9930 current M.U.T.C.D. <br /> Notif.l-03' 77/ California supplement. <br /> The undersigned hereby applies for permission to excavate, construct and/or otherwise encroach on County Highwa Right-of-Way on <br /> the �9si sl e of +4 v;S approximately /Z' e r�+ie��t/r# <br /> of ouTl r, zV LQ&j by performing the following work(description of work): <br /> 6 �-e s. c- rT , <br /> Work will commence on or about S D for approximatelyy 0 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 /> S S�i�9 <br /> ignature of Applicant-Title Date <br /> EIPUB-SV.WKWASTER.PSIENCROACHMENTPERMITAPPLICATICN.00C (01100) <br />