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APPLICATION FOR ENCROACHMENT PERMIT <br /> PLEASE PRINT: <br /> Date <br /> OFFICE USE ONLY <br /> To: San Joaquin County JOB# 7,359_6 REF# <br /> Department of Public Works APN <br /> CR# <br /> EXP.DATE �� f <br /> VALIDTO <br /> ! /S�o/z- DRIVEWAYS: <br /> Pac i f is Gas & Electric STREET j2 <br /> P.O. BOX 930 AREA L1JC,�E QUAD <br /> STOCKTON, CA 95201 TYPE 'S <br /> FORMS 5'S lives Z� <br /> 209-942-1627 NOTES <br /> i <br /> i <br /> I <br /> FSSee <br /> etailed plans may be submitted) <br /> Traff is Control Plan <br /> attached sketch. shall be as per <br /> current M.U.T.C.D. <br /> PMS g5q --�57a California supplement <br /> Notif. <br /> thee undersigned hereby applies for permission to excavate,construct and/or otherwise encroach on Count Hi _ <br /> side of �, ( y Highway Right-of Way on <br /> of approximately 5"7�' feet/�e"P= t <br /> by performing the following work(description of work): <br /> Work will commence on or about 1 <br /> for approximately days.. <br /> I,the undersigned,certify that I am the owner of the respective property,or am qualified to represent <br /> the owner and'agree <br /> work described above in accordance with the rules and regulations of San Joaquin County and subject to inset n to do the <br /> � p and approval. <br /> tUMMAM <br /> i <br /> Signature of Applicant-Title <br /> DaAe <br /> EAPRPSIENCROACHMENT PERMITAPPUCATION.DOC(01!08) <br /> Return Permits to: <br /> CCD <br /> P.O. Box 930 <br /> Stockton, CA 95201-0930 <br />