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APPLICATION FOR ENCROACHMENT PERMIT <br /> PLEASE PRINT: I <br /> Date U Me)J 6' OFFICE USE ONLY <br /> To: San Joaquin County JOB# 73G63a- REF# <br /> Department of Public Works APN CR# <br /> EXP.DATE S /Z <br /> VALID to. 6/S/z DRIVEWAYS: <br /> Pacific Gas & Electric STREET ✓ ,,11Xor�D <br /> P.O. BOX 930 i AREA t4cozowi tYf QUAD AIZ41 <br /> TYPE 2WZ-,,— � <br /> STOCKTON, CA 95201 FORMS Z-I <br /> 209-942-1627 NOTES <br /> I <br /> Sketch(Detailed plans may be submitted) <br /> Traffic Control Plan � <br /> shall be as per j <br /> See attached sketch. current M.U.T.C.b. <br /> California supplement i <br /> PM 4l &cam C 2-07 <br /> Notif. DE6 �5 1 014 <br /> The undersigned hereby app <br /> lie for permiss'on to excavate,construct and/or otherwise encroach on County Highway Right-of-Way on <br /> the side of approximately G7_3' feet/ <br /> of ,by performing e following work(description of work): <br /> D <br /> Work will commence on or about for approximately. I P)n 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 /> Signature of Applicant-Title Date <br /> E:IP MMASTER.PSIENCROACNMENTPERMITAPPUCATION.DOC(01108) ' <br /> Return Permits to: <br /> CCD <br /> P.O. Box 930 <br /> Stockton, CA 95201-0930 <br />