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APPLICATION FOR ENCROACHMENT PERMIT <br /> PLEASE PRINT: <br /> Date ' l / k% OFFICE USE ONLY <br /> TO: San Joaquin County JOB # 77�` REF # <br /> Department of Public Works . APN CR # <br /> ' <br /> EXP. DATE '3'//-0 7 <br /> VALID h�-/a-�G TO -3-11-02 DRIVEWAYS: <br /> (Applicant Name) STREET ��FCP�ft1 -P-c�t{fl <br /> r!�� AREA LW - QUAD NE <br /> L) TYPE <br /> (Mailing Address) FORMS -29, <br /> -? �f -NOTE <br /> (City, State, Zip Code) <br /> (Area Code - Telephone Number)_ r <br /> ac <br /> roetA (I4tailed plans may be submitted) TRAFFIC CONTROL PLAN <br /> Q 2 SHALL BE AS PER <br /> C:) CURRENT M.U.T.C.D. <br /> M CALIFORNIA SUPPLEMENT <br /> a , <br /> Z. <br /> Q 2 <br /> N 4s1 <br /> The undersigned hereby applies for permission to.excavate, <br /> . nstruct and/or <br /> of encroac4n--Count Highway Right-of-way-on-3;-14'on- a sideS <br /> of <br /> approximately /miles <br /> of i l ,t- by 'performing the <br /> following work (desc�ript�o P work) -- ✓�P <br /> Work will commence on or about 1;411 le for approximately <br /> G� <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 /> C1 <br /> Signature of Applicant - Title Date <br /> . M3LSTSR.P9\FSBSC9DL (6/00) <br /> I <br />