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APPLICATION FOR ENCROACHMENT PERMIT <br /> PLEASE PRINT: <br /> Date 1 OFFICE USE ONLY <br /> JOB# 720o�-�P REF# <br /> To: San Joaquin County CR# <br /> Department of Public Works APN <br /> EXP.DATE <br /> VALID ! 11 0. DRIVEWAYS: <br /> Pac if is Gas & Electric ST AREA STREET <br /> �, E QUAD <br /> P.O. BOX 930 TYPE e neh <br /> STOCKTON, CA 95201 ' FORMS !u� <br /> 209-942-1627 I NOTES <br /> Sketch(Detailed plans may be submitted) <br /> Traf f is Control Plan <br /> shall be as per i <br /> See attached sketch. current M.U.T.C.D. <br /> California supplement <br /> PMS <br /> Not if. l I b�- Z- <br /> The undersi ned hereby applies for permission to excavate,construct and/or otherwise encroach County Highway Right-of-Way on <br /> the <br /> ` side of approximately �.� feet/. e <br /> of je_. ,by performing the following work(description of work): <br /> 41 <br /> 14 tl-Z— <br /> Work will commence on or about for approximately ll� days. <br /> I,the undersigned, that I am the owner of the respective property,or am qualified to represent the owner and agree to do the <br /> certify <br /> work described above in accordance with the rules and regulations of San Joaquin County and subject to inspection and approval. <br /> UWU <br /> Signature of Applicant-Title Date <br /> E-APU KIMASTERPSIENCROACHMENTPERMRAPPLICATION.DOC (01/08) Return Permits to: <br /> CCD <br /> P.O. Box 930 <br /> Stockton, CA 95201-0930 <br />