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APPLICATION FOR ENCROACHMENT PERMIT <br /> PLEASE PRINT: <br /> Dated OFFICE USE ONLY <br /> To: San Joaquin County JOB# `` <br /> �.%d`�->L- 'G1 REF# <br /> Department of Public Works APN CR# <br /> EXP.DATE // S <br /> Pacific Gas and Electric Co. VALID - , ,, T DRIVEWAYS: <br /> P.O. BOX 930 STREET , <br /> AREA l—, ;Eru /'QUAD GLa <br /> Stockton, CA 95201 TYPE <br /> FORMS <br /> NOTES <br /> (Z09 ) ``'142- 1627 <br /> (Area Code-Telephone Number) <br /> Sketch(Detailed plans may be submitted) <br /> SEE ATTACHED SKETCH Traffic Control Plan <br /> Shall be as per <br /> PMS current M.U.T.C.D. <br /> NOTIF: ; w:fcc�.° �_� California supplement. <br /> The undersigned hereby applies for permission to excav te,construct and/or otherwise encroach on County Highway Right-of-Way on <br /> the side of approximately '7!'") feet/rpite <br /> of ✓ <br /> by performing the fol! wingw" rk(description of work): R <br /> Work will commence on or about i i I I for approximately da s. <br /> Y <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 /> Q �.,It..iry • r �la� , � � � <br /> Signature of Applicant-Title Date <br /> &SV.WKIMASTER.PSIEICROACHMENT PERMIT APPLICATKtt100C (01" <br /> Return permits to: <br /> CCD <br /> P.O. Box 930 <br />