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APPLICATION FOR ENCROACEMENT PERMIT <br /> PLEASE PRINT; <br /> �g OFFICE USE ONLY <br /> Date <br /> To: San Joaquin County JOB # rl3dS2-� REF # <br /> Department of Public Works APN _-- — — CR # <br /> EXP. DATE <br /> VALID TO/ l DRIVEWAYS <br /> STREET ��99/�' <br /> PG&E AREA QUAD tiu> <br /> 4040 WEST LANE TYPE 'G� <br /> FORMS <br /> STOCKTON, CA 95204 NOTE <br /> (City, State, .Zip Code) <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 /> PM <br /> 70� <br /> NOTIF: 9 o <br /> The undersigned hereby applies for permission to.excavate, .cons, ruct and/or <br /> otherwise-encroach on County Highway Right-of-Way-os-the <br /> side.of <br /> (.n _ approximately Afeet/wA= <br /> of IVN 11 ,2 _� , bey performing the <br /> _. _..___._ following-waxk_(descpt,ion of,work}_: 1hp <br /> 7A i <br /> Work will commence on or about for approximately <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 /> ate <br /> S ature of Applicant - Title <br /> MAS=.PS\MS®L (6/00) RETURN PERMITS TO:'' <br /> i <br /> NAE <br /> STQCtFTON,.JA" 95201, <br />