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APPLICATION FOR ENCROACHMENT PERMIT <br /> PLEASE PRINT: <br /> Date �� (LJ I 10 OFFICE USE ONLY <br /> To: San Joaquin County JOB# ?3 at2—E, REF# <br /> Department of Public Works APN CR# <br /> EXP.DATE -1- <br /> Pacific Gas and Electric Co. VALID �zV'1C) Tb �- l�2d QDRIVEWAYS: <br /> STREET <br /> P.O. BOX 930 AREAroAQUAD <br /> Stockton, CA 95201 TYPE a & <br /> FORMS tn� <br /> NOTES <br /> � l '942- 16Z-7 <br /> (Area Code-Telephone Number) <br /> Sketch(Detailed plans may be submitted) <br /> Traffic Control Plan <br /> SEE ATTACHED SKETCH Shall be as per <br /> current M.U.T.C.D. <br /> PMT&I=3wr'0 California supplement. <br /> NOTI F: 2l <br /> The undersigned hereby applies for permission t excavate,construct and/or otherwise encroach on County Highway Right-of-Way t on <br /> the side of - . '' approximately > feet/=k�"�. 7 <br /> of by performing the following work(description of work): <br /> ee 46 114w <br /> qJ <br /> Work will commence on or about ,40 for approximately z> days. <br /> I,the undersigned,certify that I am the owner of the respective property,or am qualified to represent the owner and agree to do the <br /> work described above in accordance with the rules and regulations of San Joaquin County and subject to inspection and approval.. <br /> o chi l�aQ r 8 jib I o <br /> Signature of Applicant-Title Date <br /> &SV.WKIMASTER.PSIENCROACHMENT PERMIT APPUCATION.DOC (0710 <br /> Return permits to: <br /> CCD <br /> P.O. Box 930 <br /> Stockton, CA 95201-0930 <br />