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APPLICATION FOR ENCROACrMdENT `PERMIT <br /> PLEASE PRINT: . <br /> Date 409 OFFICE USS ONLY <br /> To: San Joaquin County JOB # 73C>C>S'Z ggg # <br /> Department of Public Works APN _ CR # <br /> EXP. DATE 3 <br /> /± VALID. TO DRIVEWAYS <br /> PG&E STREET eV.C y <br /> AREAf�QUAD <br /> 4040 WEST LANE TYPE � t'� * :--- <br /> FORMS. 1+ •' QZq. <br /> STOCKTON, CA 95204 NOTE <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 3066'!:�235 <br /> NOT-IF: w3.25/53 7 <br /> The undersigned hereby applies for permission to.excavate, .con.s.truct and/or <br /> otherwise-encroach on County Highway Right-of-Way--o$.-the .(O&W side.of <br /> z2fazl:zz 4f imp 2L approximat'ely '-/90 feet/fie 6,4S7- <br /> of 45Y. FRF.. Vel/ L'1�M12. 1Yry-performi.itg the <br /> E x c.gvr�rE BELL LADLE DUGlt L/QS r14s9i� .t7xl� BORE <br /> .STltt"L T TD _rA1S7f4LL A/E_[.J -IgS <br /> Work will commence on or about 1. -2 9-Ov for approximately <br /> 9D 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 inwork described above n . <br /> accordance with the rules, regulations 'of San Joaquin County and subject to <br /> inspection and approval. y <br /> aS�'. T�9� EsTir�r�TaR %D-.28 DB <br /> kgna�tur4ofApplicant Date <br /> awsxsx.Ps�asssc�r cs/oa> RETURN PERMITS TO: <br /> CCD <br /> P&&E <br /> P.O. BOX 930 <br />