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APPLICATION FOR ENCROACHMENT PERMIT <br /> PLEASE PRINT: <br /> Date <br /> OFF( -E USE ONLY <br /> To: San Joaquin County JOB# 7 "�in <br /> Department of Public Works APN <br /> EXP.DATEVALID SDRIVEWAYS: <br /> A G. &E CO. STREET4040 WESTLANE AREA <br /> TYPE <br /> .STOCKTON, CA .95204 FORMS low Re- <br /> NOTES <br /> r <br /> (Area Code-Telephone Number) <br /> 7Sketch_(Detailed plans may be submitted) <br /> Traffic Control Plan <br /> See attached sketch. Shall be as per <br /> PM j: v,1__ P current M.U.i.C.D. <br /> Motif. _ California supplement. <br /> J i <br /> I <br /> The undersigned hereby applies for permission to excavate,con truct and/or otherwise encroach on County(high+relay Right-of-Way on <br /> the .0 _side o 1 5 ;�, .fin ' <br /> or �/r� i�l�r n ��Lr, <br /> approximately e- a rife�. <br /> r' <br /> by performing the follo�ring work Description of work): <br /> e, <br /> "r,-,C <br /> Work will commence on or about. for approximately <br /> . _ 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-Tive <br /> ate <br /> E:IPIIB-SV.WKVAS 71R.PSIENCROA.CHV.SvTpE4MtTA..pUCA ON.C)CC (01i0E) l <br />