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APPLICATION FOR ENCROACHYONT PERMIT <br /> PLEASE PRINT: . <br /> Date OF7ICE USE ONLY <br /> To: San Joacui_- County JOB # <br /> Department of Public Works APN CR: . <br /> EXP. DATE <br /> VALID T4 /O/S-GK+ DRIVEWAYS <br /> VALID- <br /> PG&E sTi��r �,,.,.�,�.,�-o �. <br /> ARSA QUAD �YaJ <br /> 4040 WEST LANE TYPE /.0axe-400-510,411VFORMS <br /> STOCKTON, CA 95204 NOTE <br /> (City, State, Zip Cade) <br /> mea Code - Telephone Number) <br /> Sketch (Detailed plans may be submitted) <br /> TRAFFIC COP:TROL P! AN <br /> SHALL BE AS PER <br /> CURRENT AA.U-T.C.E). <br /> CALIFORUTA SUFPL_Mc <br /> SEE ATTACHEb SKETCH <br /> PMS '. <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 _ 4 2o7-AL side5.of <br /> r rZ Sr3c �s.v, fr'a r �S garq S."),!5 o.g' t.._?. Z7 <br /> S6U77-16W A, e, : by performing the <br /> _._._-foI I owing__w0_rk_(cit r ptio _of__worKl <br /> 17 1 <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,' regulatious 'of San Joaquin County and subject to <br /> inspection and approval. <br /> eS '_ � E�3'�rnr�ToR ,r� 3r <br /> gnature of Applicant -• Title <br /> 90 :01 WVD t�N fir 804 . <br /> M1.STStt.PS\P$d;®Z, (6/00) <br /> ! ,. r RETUPN PERMITS TO: <br /> CCD <br /> P&&E <br /> 7` 7i P.O. BOX 930 <br /> *02 STOCKTON,CA 95201 <br />