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APPLICATION FOR ENCROACHMENT PERMIT <br /> PLEASE PRINT: <br /> Date ,.� OFFICE USE ONLY <br /> To: San Joaquin County JOB# 13002—G REF# <br /> Department of Public Works APN CR# <br /> EXP.DATE —I—" <br /> VALID 1 2o\tT0 DRIVEWAYS: <br /> Pacif is Gas & Electric STREETr �4 C?_ <br /> AREA G <�O '• t . ,QUAD N <br /> P.O. BOX 930 TYPE r <br /> STOC KTON, CA 95201 FORMS ��fes, Q�2 <br /> 209-942-1627 NOTES <br /> Sketch(Detailed plans may be submitted) <br /> Traff is Control Plan <br /> shall be as per <br /> See attached sketch. current M.U.T.C.D. <br /> California supplement <br /> PM L"%'ce <br /> The undersigned hereby applies for permission to excavate,construct and/or otherwise encroach on County Highway Right-of-Way on <br /> the -044-\ —side of 'Q -'t approximately 3 feetl�#e <br /> of x • by performing the following work(description of work): <br /> ti u r v <br /> Work will commence on or about I for approximately I ,rd- 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 /> \0kaw-u, <br /> Signature of Applicant-Title ate <br /> Eft S%ENCR0A0HME4TPBWAPPUCn0N.D0C(01108) <br /> Return Permits to: <br /> CCD <br /> P.O. Box 930 <br /> Stockton, CA 95201-0930 <br />