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APPLICATION FOR ENCROACHMENT PERMIT <br /> PLEASE PRINT: <br /> ,l <br /> Date f,` �,✓ .�� OFFICE USE ONLY <br /> To: San Joaquin County [APN <br /> OB# �3c�� � �_ REF# <br /> Department of Public Works CR# <br /> XP.DATEVALID -2(�-Z corp 1 G- - `r DRIVEWAYS: <br /> A G. &E. CO. STREET <br /> 4040 WEST LANE AREA C-KTC'4 QUAD N�-- <br /> TYPE STOCKTON, CA 95204 FORMS �S I t 6 t 'L r� <br /> NOTES _ <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 .� _!,',�.a-fir`-v% ' <br /> current M.U.T.C.D. <br /> Notif.,j J r California supplement. <br /> The undersigned hereby applies for permi sio tQ excavate, construct and/or otherwise encroach on ount Hi hwaR'i ht <br /> the_ ¢�)'' side of_ � ,� Y 9 g of-Way on <br /> approximately �" <br /> Of „_ h !�? a _-' < f Y—� �_t-_ t,fees - <br /> ---�7 by -rferming the fognwin L��^'f rd �cri <br /> es +' nr 1 <br /> 1 plion Gi wo-,k). <br /> Work will commence on or about l <br /> 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 <br /> Date <br /> E"PUB-SV.WKIMASTEP.PSIENCROAC4MEWPERMITAPPLICA7ICN.000 (01108) <br />