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APPLIC.LTION FOR ENCROACffi�iENT PERMIT <br /> PLEASE PRINT .. <br /> Date / OFFICE' IISS ONLY <br /> To: San Joaquin_ County JOB # t3�J�o-�o REEF ## <br /> Department of Public Works APN CR # <br /> EXP. DATE Co•1,0AV; <br /> /± <br /> VALID- M-1-09'. .TO _ !v•1•aa DRIVEWAYS: <br /> PG&E STREET -5i r rk J7: � <br /> AREA.F4KM OQAD <br /> 4040 WEST LANE TYPE c o <br /> STOCKTON, CA 95204 FORMS. rxJu� - 4 <br /> NOTE <br /> (City, State, .Zip Code) <br /> - <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 ? Cv70&5`1 <br /> NOTIF: Lo-� lg�Z� <br /> The undersigned hereby applies for permission to.excavate, onst ct and./or <br /> otherwise-encro ch on County Highway Right-of-Way---on-the G - si .of . <br /> approximately AI _Z�l feet/mile b� <br /> of by -per€orrrdn the <br /> __.__.r_______^follo�ving�v �_ crpton of-work) <br /> Work will commence on or about for approximately <br /> 8 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 sub]ect to <br /> inspection and approval. <br /> t l 20 a <br /> S ture of Applicant - Title iate <br /> 1N1S M-PS\MMS®L (s/oo) RETURN PERMITS TO: . <br /> CCD <br /> PG&E <br /> P.O. BOX 930 \ <br /> STOCKTON-CA 95201 <br />