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APPLICATION FOR ENCROACM-ENT ,PERMIT <br /> PLEASE PRINT: <br /> Date �i�- I lJ OFFICE USE ONLY <br /> To: San Joaquin County JOB # f 30!�)5 Z_(p REF # <br /> Department of Public Works , APN CR # <br /> EXP. DA E <br /> VALID, a8 TO i1-► -vg DRIV$9QAYS <br /> PG&E STREET <br /> AREA QUAD SVG✓ <br /> 4040 WEST LANE TYPE cc oL -W..oe q <br /> FORMS. <br /> STOCKTON, CA 95204 NOTE — <br /> (City, State, .Zip Code) <br /> CZog7gA2- 121 . <br /> (Area Code - Telephone 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 /> SEE ATTACHED SKETCH <br /> PM17��5 <br /> NOTIF: 100577185 <br /> The undersigned hereby applies for permission to .excavate, construct and./or <br /> otherwi enc oach on ounty Highway Right-of-Wa •oa the tlh, side.of - <br /> approximately feet/me � eS <br /> of bAl(, ,• by'per€or_ ming the <br /> ____ —�olloJnti _ szzk�scrI tion of-work).: <br /> IL -- ----- -- <br /> Work will commence on or about for approximately <br /> 1P2C 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 /> V <br /> 9Z <br /> S :tura of Applicant - Title Date <br /> 1QST3R.PS\MMS®L (6/00) RETURN PERMITS TO: <br /> CCD <br /> P&&E <br /> P.O. BOX 930 <br /> STOCKTON,CA 95201 <br />