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gpPLICATION FOR ENCROACHMENT PERMIT <br /> PLEASE PRINT:' ., <br /> OFFICB USE ONLY <br /> Date - <br /> JOB # 7 ZC�,S'2- REF # <br /> To: San Joaquin County APN CR ' # <br /> Department of Public Works Exp. DATE <br /> VALID. TO DRIVgWAYS <br /> STREET <br /> PG&EAREA <br /> ,�. � Qom _ * _` <br /> TYPE <br /> 4040 WEST LANE FORMS / (a, � , <br /> STOCKTON, CA 95204 NOTE <br /> (City, State, Zip Code) <br /> (Area Code Telenhone 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 /> SSE_ ATTACHED SKETCH <br /> PM 3DO38 LIy 7 <br /> NOTIF -7 y� <br /> The undersigned he applies for permission to-excavate, construct and/or <br /> side - <br /> otherwise-encroach on Count-Y-1-1ighway Right-of-Way ora the A/D�2Tf1_— <br /> _ <br /> LMAIL 41 e RL , approximately OPP)S/Z�c THE <br /> • & Df to rN Sr. L3�INTI,? by per€orming the <br /> descri tion of work) . <br /> — <br /> C x c�v�T'E d CL L /�/DL L DUER �`4.� /Y✓�/rV /�.U� %���' _-- <br /> T/!E 97W,e5E7' Tv iJ <br /> tely <br /> Work will commence on or about <br /> for approxima <br /> 9D 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 /> Date <br /> gnature of Applicant Title <br /> r+A u <br /> MAS=M.PS\Fees®L (5/00) RETURN PERMITS TO: - <br /> i <br /> CCD <br /> PG&E \ <br /> P.O. BOX 930 <br /> STOCKTON.CA 95201 <br />