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APPLICATION FOR ENCROACHMENT PERMIT <br /> PLEASE PRINT: <br /> Date OFFICE USE ONLY <br /> To: San Joao iin County JOB# �N4 95.2— REF# <br /> Department of Public Works APN CR# <br /> EXP.DATE 66V_1/z- _ <br /> VALID / /S /.'� DRIVEWAYS: <br /> Pacit'ic Gas & Electric STREET ,�E Ifi� . <br /> P.O. BOX 930 AREA 3,-.0414 AI QUAD <br /> TYPE 'BGG f/oLE <br /> STOC'KTON, CA 95201 FORMS s✓y✓ 24 <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 /> PM California supplement <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 me '* _side of " ,. s° approximately � � feetAr& <br /> off * t: N(performing the following work(description of work): <br /> Work will commencrl 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 /> VAn oi' ' ° L <br /> Signature of Applicant-Title Date <br /> E:1PU HIMASTERPS'ENCROACHIAENTPERSATAPPIICATION.DOC (01108) <br /> Return Permits to: <br /> CCD <br /> P.O. Box 930 <br /> Stockton, CA 95201-0930 <br />