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APPLICATION FOR ENCROACHMENT PERMIT <br /> PLEASE PRINT: <br /> Date ' s` i a .` OFFICE USE ONLY <br /> To: San Joaquin County JOB# REF# <br /> Department of Public Works APN CR# <br /> EXP.DATE <br /> Pacific Gas and Electric Co. VALID o .. DRIVEWAYS: <br /> STREET <br /> P.O. Box 930 AREA QUAD & <br /> Stockton, CA 95201 TYPE <br /> FORMS <br /> NOTES <br /> �2,Pq ) 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 :r _ 1 I current M.U.T.C.D. <br /> California supplement. <br /> NOTIF: . �� � � . .. i <br /> The undersigned hereby applies for permission to a cavate, construct and/or otherwise encroach on County Highway Right-of-Way on <br /> the e "' r ,,. side of 1 i-�_ t approximately y �. feeWM& <br /> �.��"a� <br /> by performing the followinw k(description of work): <br /> a'jf <br /> Work will commence on or about 1 . t C for approximately . t 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 /> LIVNIKIMASTEP PSAENCROACHMENT PERMIT APPUCATIDN,DDC (07108) <br /> Return permits to: <br /> CCD <br /> P.O. Box 930 <br />