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PLEASE PRINT: APPLICATION FOR ENCROACHMENT PERMIT <br /> Date <br /> To: San Joaquin County OFFICE USE ONLY <br /> Department of Public Works JOB# f �� <br /> REF# <br /> APN <br /> EXP.DATE CR# <br /> Pacific GasVALID ` f� <br /> 8c Electric O I STREET f z DRIVEWAYS: <br /> P.O. BOX 930 1 AREA �.✓ <br /> STOCKTONI TYPE t�QUAD <br /> CA 95201 <br /> 209-942-1627FORMS <br /> I NOTES <br /> I <br /> Sketch(Detailed plans may be submitted) <br /> Traffic Control Plan <br /> See attached sketch. shall be as per i <br /> current M.U.T.C.p. <br /> PM07 7 71 7 California supplement <br /> Notif. � <br /> 105��0 z � <br /> The undersigned hereby applies for permission to excavate construct and/or otherwise <br /> the Iund }- side of <br /> of e encroach on County Highway Right-Of-Way on <br /> approximately ';2 =_feet/�ile. cr 1 <br /> performing the following work(description of work): <br /> � G4f- <br /> Work will commence on or about j <br />, the undersigned,certify that I am the owner of the respective Property,or for approximately�, <br /> v h described above ti accordance with the rules and regulations of San Jo days. <br /> am qualified to represent the owner and agree to do the <br /> }� Joaquin County and subject to inspection and approval. <br /> ' <br /> Signature of Applicant-Title �.• Z6- I 1 <br /> D K'MASTER.PBIENCROACHMENrPERMrTAPPUCATION.DOC(01N8) ` Date <br /> 1 <br /> Return Permits to: <br /> CCD <br /> P.O. Box 930 <br /> Stockton, CA 95201-0930 <br />