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Aj?PLICATION FOR ENCROA.CKMENT PERMIT <br /> PLEASE PRINT; <br /> Date q 'C�� OFFICE USE ONLY <br /> To: San Joaquin_ County JOB # / 5 REF # <br /> Department of Public Works APN CR # <br /> EXP. DATE <br /> PC <br /> Rp VALID TO -/`i C" DRIVEWAYS: <br /> PCME STREET T ' ' <br /> AREA��� ?Da�+/ QUAD <br /> 4040 WEST LANE TYPE <br /> FORMS <br /> STOCKTON, CA 95204 NOTE <br /> (City, State, Zip Code) _- <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 /> CALIFORNIA SUPPLEMENT <br /> SEE ATTACHED SKETCH <br /> PM2�� <br /> NOTIF: <br /> The undersigned hereby applies for permission to-excavate, cons, ct and/or <br /> other,'se- encroach on County Highway Right-of-Wary-on-the side.of <br /> on approximately __ feet/fie 14Aef�-E <br /> of Ale- y--performing the <br /> _._.__._____f.o11 wing-�wQrk_.(description of,work)_:_ Q/ <br /> Work will commence on or about for approximately <br /> too days. <br /> I, the undersigned certify that I am the owner of. the re spective, 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 /> ature of Applicant Title Date <br /> Se <br /> MASTM.PS\MSC=L (6100) RETURN PERMITS TO: <br /> CCD . <br /> PG&E <br /> P.O. BOX 930 <br /> STOCKTON,CA 95201 - <br />