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APPLICATION FOR ENCROACHMENT PERMIT <br /> PLEASE PRINT: <br /> Date �Vzt)l I I OFFICE USE ONLY <br /> To: San Joaquin County JOB# 7.30D�o? REF# <br /> Department of Public Works APN CR# <br /> EXP.DATE <br /> VALID Tb. /S / DRIVEWAYS: <br /> Pacific Gas & Electric STREET /L /// <br /> P.O. BOX 930 AREA wldidowA QUAD yrs! <br /> TYPE yDG�G <br /> STOCKTON, CA 95201 FORMS SS L{j�7, - <br /> 209-942-1627 I NOTES <br /> I <br /> Sketch(Detailed plans may be submitted) <br /> Traffic Control Plan <br /> shall be as per <br /> See attached sketch. current M.U.T.C.D. <br /> California supplement <br /> Pm <br /> Notif. <br /> The undersigned hereby applies for permission to excavate,construct and/or otherwise encroach on County Highway Right-of-Way on <br /> the side of approximately Z 17— feetlm e Wc-) <br /> of A4ylri_ati1 a �4 �zby performing the following work(description of work): <br /> 11 b <br /> Lx_-) Lb 1i re,41-) ,) <br /> `Work will commence on or about for approximately 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 /> 661,2 1�0h64-,6r 41 X11 <br /> Signature of Applicant-Title Date <br /> E:1P KIMASTERPSIENCROACHMENTPERMITAPPUCATION.00C(01108) <br /> Return Permits to: <br /> CCD <br /> P.O. Box 930 <br /> Stockton, CA 95201-0930 <br />