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APPLICATION FOR ENCROACHMENT PERMIT <br /> PLEASE PRINT: <br /> Date 1-_�/i�.;l 1' j <br /> To: San Joaquin County x OFFICE USE ONLY <br /> Department of Public Works APN JOB# P � p' REF# <br /> EXP.DATE CR# <br /> ' <br /> PaVALID cif is Gas � Electric T <br /> STREET L__ DRIVEWAYS: <br /> P.O. BOX 930 AREA <br /> STOCKTON, CA 95201 TYPE QUAD > BD <br /> `�� <br /> 209-942-1627 I NOFORMS ss , Z <br /> I TES <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.p. <br /> PM =' iF California supplement <br /> The undersigned hereby applies for permission to excavate construct and/or otherwise encroach <br /> of <br /> side of ,r on County Highway Right-of-Way on <br /> f approximately ems, - <br /> : �.. b — r feet/w* <br /> y performing the following work(description of work): <br /> 9 ! ✓i p^. <br /> Work will commence on or about r :3 <br /> 1,the undersigned,certify that I am the owner of the respective pro e for approximately w <br /> days. <br /> work described above in accordance with the rules and regulations a San Joaquin County and <br /> Property,or am qualified to represent the owner and agree to do the <br /> tY subject to inspection and approval <br /> Signature of Applicant-Title <br /> tM%SM.pu .IPSENCRpgC}HMENTP Dat <br /> �aPPucanoN.00c ccwe� <br /> Return Permits to: <br /> CCD <br /> P.O. Box 930 <br /> Stockton, CA 95201-0930 <br />