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APPLICATION FOR ENCROACHMENT PERMIT <br /> PLEASE PRINT. <br /> Date 10- Z6- I M OFFICE USE ONLY <br /> To: San Joaquin County JOB# REF# <br /> Department of Public Works APN CR# <br /> EXP.DATE <br /> VALID o // TO f ,62 DRIVEWAYS: <br /> Pacif is Gas & Electric STREET fit/ <br /> P.O. BOX 930 1 AREA QUAD ,yf <br /> TYPE <br /> STOCKTON, CA 95201 FORMS �iv, <br /> 209-942-1627 NOTES <br /> I <br /> Sketch(Detailed plans may be submitted) <br /> Traffic Control Plan ! <br /> shall be as per <br /> See attached sketch. current M.U.T.C.D. <br /> California supplement j <br /> PMS <br /> Notif. 10-F4- bl 0 2 z <br /> The undersigned hereby applies for permission to excavate,construct and/or otherwise encroa h on County Highway Right-of-Way on <br /> the 21 side of approximately & ` feetla�e _ <br /> of -9 ,by performing the following work(description of work): <br /> �(YL@ 7 G t� t1 xte'6L <br /> Work will commence on or about i 0/i!2l 1 i 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 /> &D� alu � Y <br /> Signature of Applicant-Title Dat <br /> E�Pu . RIMASTEPPSIENCROACNMENTPERMRAPPUCOON.DOC (01108) <br /> Return Permits to: <br /> CCD <br /> P.O. Box 930 <br /> Stockton, CA 95201-0930 <br />