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- APPLICATION FOR ENCROACHM= PERMIT <br /> PLEASE PRINT: <br /> Date OFFICE USE ONLY <br /> TO: San Joaquin County JOB # � ��S �-` REF # <br /> Department of Public Works APN CR # <br /> EXP. DATE O -I —O? <br /> VALID TO10-l- O a DRIVEWAYS <br /> (Applicant Name) STREET 6<4^ KI>' <br /> AREA QUAD _ <br /> TYPE <br /> (Mailing Address) FORMS z <br /> NOTE <br /> �� �r✓ C►9. 9s'z�� <br /> (City, State, Zip Code) <br /> (Area Code - Telephone Number) , - <br /> Sketch (Detailed plans may be submitted) TRAFFIC CONTROL PLAN <br /> ,j ol0�3�I8 SHALL BE AS PEP <br /> 1027494:4q CURRENT M.U.T.C.D. <br /> CALIFORNIA SUPPLEMENT <br /> RETURN PERmms TO, / l l / <br /> PG&E - BLD I > Gco '5kee6�i <br /> JOB PROCESS*4G DESK. <br /> X M V1hst LWW <br /> 91 OC1tTM,CA 95204 <br /> The undersigned hereby applies for permission to.excavate, construct and/or <br /> otherwiseencroachon County Highway Right-of-Way-on-the_ side..of <br /> /er9ftle <br /> �,�/, approximately�,���/ Ro._ %.5' <br /> of SST �0.. , by erjormirig the <br /> following work (descript'o of work) : <br /> �O �D�. �Z� 8e1/� 6P9 S /A/ j <br /> Work will commence on or about for approximately <br /> O <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 /> cs�e�Pi L �A 1 <br /> Signature of Applicant - Title Date <br /> 1' S .PS\MMS®L (6/00) - \ <br /> i <br />