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APPLICATION FOR ENCROACHMENT PERMIT <br /> PLEASE PRINT: <br /> Date DEC 9 2006 OFFICE USE ONLY <br /> TO: San Joaquin County JOE # x•3052-41 REF # <br /> Department of Public Works APN CR # <br /> r EXP. DATE Y017,59 <br /> Gi . VALID f dC,v TO ®. V DRIVEWAYS <br /> (Applicant Name) STREET 9 STRF�T <br /> o4L/(4rC/ LJ gJr Lt4AREA sroc�TgU QUAD 55 * <br /> TYPE -u AMZ S � <br /> (Mailing Address) FORMS. _SS�ww f �?9 <br /> NOTE <br /> 6A 15ZP+ <br /> (City, Stafe, .Zip Code) <br /> -Zoe? 4M I It <br /> (Area Code - Telephone Number) <br /> c� <br /> Sketch (Detailed plans may be submitted) i7i <br /> TRAFFIC CONTROL RLAN� D0 <br /> SHALL BE AS PER <br /> CURRENT M.U.T.C.D. <br /> CALIFORNIA SUPPLFDAEtV A' <br /> cn <br /> Nor.tel D Z 5+& 13 ar.4 <br /> The undersigned hereby applies for permission to.excavate, .construct and/or <br /> othse-e c adh on County Highway Right-of-Wa --on-fhe 3oc-� side.:of •- <br /> approximately _ feet/and= �'i= W <br /> of M' �� D1� by -performing the <br /> following work (description of: work) : <br /> 1.IAAC.. 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 <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 /> insp and approval. <br /> 'DEC - 9 2006 <br /> Signature of App i t - Title Date <br /> R STSR.MFSSS®L (6/00) - `• <br /> . I <br />