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APPLICATION FOR ENCROACHMENT PERMIT <br /> PLEASE PRINT: <br /> Date ` OFFICE USE ONLY <br /> To: San Joaquin County JOB# REF# <br /> Department of Public Works APN _ CR# <br /> EXP. DATE t <br /> VALID !E, 7.o T6 1:2 ,- t DRIVEWAYS: <br /> Pacil=ic Gas & Electric STREET Ls jLi6E pb, <br /> P.O. BOX 930 AREA AA22DAQ UAD <br /> TYPE {3ENCt r Vrr <br /> STOC°KTON, CA 95201 FORMS - <br /> 209-942-1627 NOTES <br /> �J✓IE.PI��UG <br /> Sketch(Detailed pans 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 f z, }- 1 side of <br /> t111 . I I L , - e1Y -�- <br /> �by performing the following work(description of work): <br /> -} x <br /> i a <br /> Work will commence on or about___.. for approximately �a 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 abcve in accordance with the rules and regulations of San Joaquin County and subject to inspection and approval. <br /> Signature of Applicant-Title Date <br /> E?PU NIMASTERPS'ENCROACHMENTPERUTAPPUCATION.000 (01A8) <br /> Return Permits to: <br /> CCD <br /> P.O. Box 930 <br /> Stockton, CA 95201-0930 <br />