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i <br /> APPLICATION FOR ENCROACHMENT PERMIT <br /> PLEASE PRINT: <br /> Date '� � �/�r OFFICE USE ONLY <br /> To: San Joaquin County JOB# REF ; <br /> Department of Public Works APN CR# <br /> EXP. DATEd�— <br /> VALID $ 0 v DRIVEWAYS: <br /> A G. &E. CO. STREET <br /> 4040 WEST LANE AREA 5-72� kM-✓ QUAD <br /> TYPE L kaLE * <br /> STDCJKTON, CA 95204 FORMS .55' .oV <br /> NOTES <br /> f� <br /> (Area Code-Telephone Number) <br /> 7S�ee <br /> tch (Detailed plans may be submitted) <br /> Traffic Control Plan <br /> attached sketch. Shall be as per <br /> M ,'�. ;;' ;,' ?r current M.U.T.C.D. <br /> Notif. California supplement. <br /> The undersigned rereby applies for permission to excavate, construct and/or otherwise encroach on County Highway Right-of-Way on <br /> ofQ ^, � ode of <�. ' �' ' ' .�' r' approximately <br /> �r*77, �✓ by performing the following work(description of work): <br /> <"S <br /> Work will commence on or about � ' <br /> for approximately_____7� 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 /> � %,%` <br /> Signature of Applicant-Title " <br /> Date <br /> EiPUB-SV.WKIMASTER.PSENCROACHMEW PtZM-T APPIICAMN.000 (01108) <br />