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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 41V� <br /> VALID /2 DRIVEWAYS: <br /> Pacif=ic Gas & Electric STREET Ae� 44c <br /> P.O. BOX 930 AREA SToeAtnh / QUAD rS <br /> TYPE _�' GG �oGE <br /> STOCKTON, CA 95201 FORMS <br /> 209-942-1627 NOTES <br /> Sketch(Detailed plans maybe submitted) <br /> Traffic Control Plan <br /> shall be as per <br /> See attached sketch. current M.U.T.C.O. <br /> California supplement <br /> Pm '5005.' ,9o4n <br /> Notif. 10!1i�41 tvC0 <br /> The u dersigned hereby applies for permission to excavate,construct and/or otherwise encroach on County Highway Right-of-WayI on <br /> " <br /> the 194& -side of Q approximately 2rJ #eet/wAe 15 <br /> of by performin the f0 o in work description of work): <br /> 14 M A,, <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 /> r <br /> Signature of Applicant-Title ate <br /> E:WUIMASTERPSIENCROACHI.IENTPER,WTAPPUCATION.DOC (01108; <br /> Return Permits to: <br /> CCD <br /> P.O. Box 930 <br /> Stockton, CA 95201-0930 <br />