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APPLICATION FOR ENCROACHMENT PERMIT <br /> PLEASE PRINT• <br /> Daae 'r OFFIC$ USE ONLY <br /> To: San Joaquin Country JOB # !3LXZ`2,,_ © REF # <br /> Department of Public Works APN CR• - # <br /> EXP. DATE 't t' -6 <br /> PG&E VALID 3�3 00' TO 10.1 �'-O DRIVEWAYS.- <br /> STREET -V4/L- 416' <br /> AREA QUAD <br /> 4040 WEST LANE TYPE 7 ,et, Ale"Ll o <br /> STOCKTON, CA 95204 Nods , <br /> (City, State, Zip Code) -- _- <br /> C2���A�� t�27 <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 /> PMd <br /> NOTIF: I L , <br /> The undersigned hereby applies for permission to ,excavate, construct and/or <br /> otherwise-encroach orti County -Highway Right-of-Way OR-the / )t _ side_of - <br /> approximately feet m4=6&of <br /> by pe'r€orming the <br /> -_- _�.o1lowing_wo. k__-(description of work) : <br /> ' i' _ J �- — ----- — <br /> Work will commence on or about /62�3 for approximately <br /> ---��� <br /> 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 rule;, regulations of San Joaquin County and subject to <br /> inspection and approval. <br /> S ature of Applicant: - Title <br /> Date <br /> MAS=.PS\Paas®n (6100) RETURN PERMITS TO: <br /> CCD <br /> PG&E <br /> P.O. BOX 930 <br /> STOCKTON,CA 95201 <br />