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APPLICATION FOR ENC <br /> ROACFIl4IENT PERMIT <br /> PLEASE PRINT: <br /> Date Z /U� ' <br /> / OFFIC$ U$8 ONLY <br /> To: San Joaquin County JOB # 730 S Z-Co REF # <br /> Department of Public Works APN CR # <br /> EXP. DATE <br /> /oy VALID TO DRIVEWAYS: <br /> (Applicant Name) STREET SP-146Ns 4 <br /> ��� AIX AREA SToc KToaJ QUAD as <br /> Z <br /> TYPE <br /> ' (Mailing Address) FORMS <br /> NOTE <br /> vc- <br /> (City, State, .Zip Code) <br /> 15-694 <br /> (Area Code - Telephone Number) <br /> Sketch (Detailed plans may be. submitted) <br /> TRAFFIC CONTROL PLAN <br /> SHALL BE AS PER <br /> CURRENT M.U.T.C.D. <br /> RETURN PERMRS TO: <br /> PGMCALIFORNIA SUPPLEMENT <br /> JOB PROCESSM DESK= BLD I <br /> �i0�10 Wrst L.�rHr �� 74or <br /> , <br /> The undersigned hereby applies for permission to.excavate, .cons•truct and/or <br /> otherwise-encroach on County Highway Right-of- <br /> Way-on theside--ofJ� <br /> approximately 73 fee /mile SDL/f77 <br /> of _ 6, c�J . by -per€or"q the <br /> following work (description of: work) : . 0 G� ', �h <br /> �✓ / �t' ch oX r G cru/ 1y <br /> XV1S C "✓t&J ,/✓Cez- .O S. . <br /> Work will commence on or about ^ for approximately <br /> 90 <br /> 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 /> C <br /> 1�2��-1�-��C.ture of Applicant- Title Da e <br /> 10 :01 Nd L- 330 900 <br /> MASTBR.PS\FRRS®L (6/00) <br /> C13 A 13 0 4:4 <br />