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APPLICATION FOR ENCROACHMENT PERMIT <br /> PLEASE PRINT: <br /> Date irl-A ' OFFICE USE ONLY <br /> To: San Joaquin County JOB# CW 0,,S2- C REF# <br /> Departme-it of Public Works APN1?3- ►,U U3 CR# <br /> EXP.DATE I 2 o t <br /> VALID TO DRIVEWAYS: <br /> Pacif is Gas & Electric STREET _ +rCc Y' ye- <br /> AREA QUAD <br /> P.O. BOX 930 TYPE F� <br /> j �ZC��.�`� <br /> STOC'KTON, CA 95201 FORMS F 2!� <br /> 209-942-1627 NOTES <br /> Sketch(Detailed pans 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 <br /> Notif. <br /> The dersi ed hereby applies for permission to excavate,construct and/or otherwise encroach on County Highway Right- -Way on <br /> the _side of 7 approximately feet* <br /> Of ,by performing the following w?�rk(description of work): <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 /> \/a&,UWU ' A/0 ��nv+ty- I <br /> Signature of Applicant-Title gate <br /> E MMASrERP51ENCPDACI ENT PUWAPPUCAnON.DCC PM) <br /> Return Permits to: <br /> CCD <br /> P.O. Box 930 <br /> Stockton, CA 95201-0930 <br />