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APPLICATION FOR ENCROACHMENT PERMIT <br /> PLEASE PRINT: <br /> Date <br /> OFFICE USE ONLY <br /> To: San Joaquin County JOB# �'5z5V �-� REF# <br /> Department of Public:Works APN CR# <br /> EXP. DATE <br /> VALID / . a TO DRIVEWAYS: <br /> A G. &E. CO. STREET <br /> 4040 9EST LANE AREA 4:::2 QUADTYPE <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 sketch. Shall be as per <br /> PM current M.U.T.C.D. <br /> Notif. �,_ <br /> i � v ; � California supplement. � <br /> The undersigned hereby applies for permission to excavate, construct and/or otherwise encroach on Count Highway Right-of-Way on <br /> the side of_ f �'//r V� ci '; Y 9 Y 9 y <br /> approximately -S ' ee ile P <br /> of_—_ — Wil/ -- by performing the following work . �ptin <br /> of work): <br /> y <br /> ,7,1,"- C.� u�/c� fiy � <,X , <br /> TQC ✓ (fi ` 141 <br /> .5 ti ? 7` CC r, c <br /> Work will commence on or about Z 'j- 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 D to ' <br /> EIPUB�SV.WK6MASTER.PSIENCROACHMENTPERMlTAPPUCATION.DCC M11081 <br />