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Return Permits to. <br /> APPLICATION FOR ENCROACHMENT PERMIT CCD <br /> P O Box 930 <br /> PLEASE PRINT: Stockton, CA 95201-0930 <br /> Date OFFICE USE ONLY <br /> To: San Joaquin County JOB# 13 6C' REF# _ <br /> Department of Public Works APN CR# <br /> EXP. DATE /Z <br /> VALID 11 0 t2 t5- i t DRIVEWAYS: <br /> Pac i f is Gas & Electric STREET * <br /> P.O. BOX 930 AREA " QUAD ,V <br /> STOCKTON, CA 95201 TYPE <br /> FORMS <br /> 209-942-1627 NOTES <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 /> Notif. - w , <br /> Thepndersigned hereby applies for permission to excavate,construct and/or otherwise encroach on County Highway Right-of-Way on <br /> the side of l approximately. 1& feet/e W x_ <br /> of by performing the following work(description of work): <br /> st y <br /> Work will commence on or about— for approximately to 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 t-0ate <br /> EAPU K.WSTERPSIENCROACHMENT PERMIT APPLICATION.DOC (01M) <br /> Return Permits to: <br /> CCD <br /> P.O. Box 930 <br /> Stockton, CA 95201-0930 <br />