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APPLICATION FOR ENCROACI00NT ;,PERMIT <br /> PL SE PRINT: <br /> Date / � - OFFICE USE ONLY <br /> To: San Joaquin County JOB # /� REF # <br /> Department of Public Works . APN _ CR # <br /> EXP. DATE -6 <br /> VALID TO 2—l—OrK. DRIVEWAYS: <br /> PG&E L STREET i <br /> AREA �QUAD <br /> 4040 WEST LANE TYPE <br /> FORMS2 Q9 <br /> STOCKTON, CA 95204 NOTA <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 /> PM % 1L9Z4 <br /> NOTIF: � � <br /> The undersigned hereby applies for permission to .excavate, construct and/or <br /> otherwise- encroach on County Highway Right-of-Way--on,the ,, s'ide;.bf <br /> approximately <br /> of LU � by"per€ormii3g the <br /> -__�._ follr�vving�e --j Vription of.work _ <br /> Work will commence on or about for approximately <br /> I IF <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 /> S ature of Applicant Title :0f Yj! ate <br /> - MASTHR.PS\PBSSCmmL (6100) RETURN PERMITS TO:: <br /> CCD <br /> PGCE <br /> P.O. BOX 930 <br /> STOCKTON,CA 95201 <br />