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APPLICATION FOR ENCROACHMENT PERMIT <br /> PLEASE PRINT: <br /> Date ° OFFICE USE ONLY <br /> To: San Joaquin County JOB# REF# <br /> Department of Public Works APN CR# <br /> EXP.DATE -p--- <br /> VALID ? p Tb DRIVEWAYS: <br /> Pacific Gas and Electric Co. STREET p ` <br /> P.O. BOX 930 AREA s+ fit QUAD (\i�. <br /> TYPE moi( l4<Ae- —rie-A •. -- E <br /> Stockton, CA 95201 FORMS ---;s <br /> NOTES <br /> 942- 162-7 <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 /> PM current M.U.T.C.D. <br /> California supplement. <br /> NOTIF: ;r <br /> The undersicined hereby applies for ermission to excavate,construct and/or otherwise encroach on County Highway Right-of-Way on <br /> the side of approximately l feet/viii� <br /> of by performing the following work (de cription of work): <br /> VW �V 14L <br /> Work will commence on or about i c for approximately 1A50 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 /> Signature of Applicant-Title Date <br /> &..WKWdASTERPSIENCROACHMENTPERMRAPPUCATIDN.DOC (0110 <br /> Return permits to,- <br /> CCD <br /> o:CCD <br /> ID n L2w awn <br />