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. x <br /> APPLICATION FOR ENCROACHMENT PERMIT <br /> PLEASE PRINT: <br /> Date I-Z•�G�9 OFFICE USE ONLY <br /> To: San Joaquin County JOB# ZIXIZ5oZ—6. REF <br /> Department of Public Works APN CR# <br /> EXP. DATE 2-15% ,Zo!4> <br /> VALID TO 0 DRIVEWAYS: <br /> A G. &E. CO. STREET <br /> i✓ ` <br /> 4040 WEST LANE AREAQUAD STYPEu.�ra,� <br /> STOCKTON.9 CA 95204 FORMS sa W�, <br /> 11 '',,rr NOTES T� <br /> UCI - <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 3 CR7 4-4la ( 7 current M.U.T.C.D. i <br /> Notif. 10 4A 39 11 California supplement. <br /> The undersigned hereby applies-for permission to excavate,construct and/or otherwise encroach on County Highway Ri ht-of-Way on. <br /> the Ef S'[" side of S bd We S ,'5M I,I approximately�g 5 feet/ <br /> of_ ^, -,L tCI—m M a�,Tprc1— by performing the followingwork(description of work): <br /> 9 <br /> 0 W-49 <br /> -V_ ► <br /> e � U <br /> r S J 1 Cc—, i W <br /> Work will commence(dn or about t Z 7 5K 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 /> Signatu a of Appl• ant-Title Date <br /> ewue.svwKMASTWSIENCRI)AauaINrPERMrrAPFUCAnonooc 01108 <br />