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APPLICATION FOR ENCROACHMENT PERMIT <br /> PLEASE PRINT: <br /> Date 46 - OFFICE USE ONLY <br /> To: San Joaquin County JOB # -73050-6o REF # <br /> Department of Public Works APN CR # <br /> EXP- DATE <br /> VALID G TO�B46 <br /> � DRIVEWAYS: <br /> (Applicant Name) STREET �7UBJE <br /> /, ,- / AREA ciboDCQlbC� NCS <br /> QUAD <br /> &C <br /> `TC I -5,�.Ups. TYPE TbE u KOC E $01CF <br /> (Mailing Address) FORMS ww,• .�L9 <br /> NOTE <br /> &W.hton , i�& 9�� -- <br /> (City, State, Zip Code) <br /> (Area Code - Telephone Number) <br /> Sketch (Detailed plans may be submitted) TRAFFIC CONTROL PLAN <br /> SHALL BE AS PER <br /> CURRENT M.U.T.C.D. <br /> CALIFORNIA SUPPLEMENT <br /> �I p <br /> v o <br /> -� rn <br /> O rn 30 <br /> Sr rn <br /> , 2-tl i <br /> !o l O fl < <br /> Om <br /> c>C <br /> The undersigned hereby applies for permission to excavate, ons ruct an&orm _ <br /> oth krise encr ach on_CQunty Highway Right-of-Way on the g8d f Z <br /> approximatel feet/raj:ime <br /> of , by performing the <br /> following ork (descripti n of work) <br /> vrch <br /> Work will commence on or about �• -�� for approximately <br /> �69 _ days_ <br /> I, the undersigned certify that I am the owner of the respective property, or am <br /> qualified to represent the owner and agree to do the work described above in <br /> accordance with the rules, regulations of San Joaquin County and subject to <br /> inspection and approval: <br /> t <br /> 6tob 2a � <br /> tSiature ofApplicant - Title Date <br /> PEPAirM TO: <br /> ESCiML (G/GO) POM _. <br /> JOB PROCESSM DESK- BLD 1 <br />