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APPLICATION FOR ENCROACHMENT PERMIT <br /> PLEASE PRINT: <br /> Date OFFICE USE ONLY <br /> To: San Joaquin County JOB# fl3oo52--6o REF# <br /> Department of Public Works APN CR# <br /> EXP. DATE Z 2- <br /> VALID <br /> VALID // to 2 / 12 DRIVEWAYS: <br /> Pac i f is Gas & Electric STREET hec <br /> AREA S7QC,�orr✓QUAD �,S <br /> P.O. BOX 930 TYPE yuGE <br /> STOt:KTON, CA 95201 FORMS <br /> -'09-942-1627 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.b. <br /> California supplement <br /> Notif. a; �tat? <br /> The undersi ned hereby applies for permission to excavate,construct and/or otherwise encroach on County Highway Right-of-Way gn <br /> the _side of_ • '�(�, '� approximately ZD5 feet/ <br /> of by performing the following work(description of work): <br /> lh6 K. ` rt 25 r <br /> t" NS. <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 /> hi-Ire <br /> E:IPLSignature of Applicant-Title D to <br /> KWASTEPPS'ENCROAC4"IEWPERMTAPPLICATICN.DOC (OV08) <br /> Return Permits to: <br /> CCD <br /> P.O. Box 930 <br /> Stockton, CA 95201-0930 <br />