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APPLICATION FOR ENCROACHMENT PERMIT <br /> PLEASE PRINT: <br /> Date _ I OFFICE USE ONLY <br /> To: San Joaqui i County JOB# pW(��30oS2- REF# <br /> Department:of Public Works APN �'� 132"02_ CR# <br /> EXP.DATE <br /> VALID -2,?ou TO b-2e t2 DRIVEWAYS: <br /> Pacific Gas & Electric STREET we <br /> P.O. BOX 930 AREA ncCv-k-lcv-,QUAD C- <br /> TYPE kk Kd _ <br /> STOCkTON, CA 95201 FORMS SS/k3&6' , 2 <br /> 209-942-1627 NOTES <br /> i <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 /> PMS <br /> Notif. <br /> Thendersig ed hereby applies for permission t excavate,construct and/or otherwise encroach on County Highway Right-of--Way on <br /> the side of approximately i,, 0 Ir feet**e 60U <br /> of Mh by performing the following work(d scription of work <br /> b l hote in -ta 117x2 A e,. <br /> Work will commence on or about /-ZEi 111 for approximately L 0 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 /> 6alb ��16+ff I <br /> Signature of Applicant-Title Date <br /> E:1PU K1MA87ERP51ENCROAGiNENf PERA4T APPIJCATION.DOC (01108) . <br /> Return Permits to: <br /> CCD <br /> P.O. Box 930 <br /> Stockton, CA 95201-0930 <br />