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APPLICATION FOR ENCROACHMENT PERMIT <br /> PLEASE PRINT: <br /> Date -2�-�;/ OFFICE USE ONLY <br /> To: San Joaquin County JOB# 73oc's .- REF# _ <br /> Department of Public Works APN CR# _ <br /> EXP. DATE <br /> Pacific Gas and Electric Co. VALID / /f TO r DRIVEWAYS: <br /> STREET � ,�� ■ <br /> P.O. BOX 930 AREA 1;#r#A5-p QUAD <br /> Stockton, CA 95201 TYPE Atmos- 3� ' <br /> FORMS <br /> NOTES <br /> --(209) 94/2 <br /> '(Area Code-Telephone Number) <br /> Sketch (Detailed plans may be submitted) <br /> Traffic Control Plan <br /> See attached sketch. Shall be as per <br /> PM current M.U.T.C.D. <br /> Notif. �sz�CJCalifornia supplement. <br /> The undersigned hereby applies for permission to excavate, construct and/or otherwise encroach on County Hiqhway Right-of-Way on <br /> the AM27'11 side of /207-/,f Ar ,S S 7; _r �, 4"114411q,, �L/7T%,1a2OP <br /> by performing the following work(description of work): <br /> E CA0/1i,E 3 3'x411s 4`17.4/.v Tvy�.a�'Prlov� <br /> 77.1 S. S S Z' <br /> Work will commence on or about 9 Bg // for approximately fir? 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 /> Q Signature of Applicant-Title Date <br /> E:XPUB-SV.WNPAASTER.PSIENCROACNMENr PERMIT APPLICATION.DOC (011M <br />