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APPLICATION FOR ENCROACHMENT PERMIT <br /> PLEASE PRINT: <br /> Date 1 17i� OFFICE USE ONLY <br /> To: San Joaquin County JOB# ya95-' REF# <br /> Department of Public Works APN CR# <br /> EXP.DATE 17— <br /> VALID 2 i TO SS DRIVEWAYS: <br /> Pacif is &as & Electric STREET ,e ?� <br /> AREA -� �' QUAD <br /> P.O. BOX 930 TYPE TiPP <br /> STOCKTON, CA 95201 FORMS <br /> 209-942-1627 NOTES <br /> Sketch(Detailed plans may be submitted) <br /> Traff is Control Plan <br /> shall be as per <br /> See attached sketch. current M.U.T.C.D. <br /> California supplement <br /> PM Don(P <br /> Notif. 1 c4l4-7o& <br /> The and rsigned hereby applie for p rmission to excavate,construct and/or otherwise encroach on County Highway Right-of-Way on <br /> the sideofALId� liJ(' approximately 010 levo feet/mileUl <br /> of L4 o 1W , by performing the following work(description of work): <br /> G �-b7 <br /> G� 7 <br /> Work will commence on or about for approximately iso 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 /> \06Dauwu <br /> Signature of Applicant-Title Date <br /> E: SrERDMCFMCHkENTPOWTAMJCATIONDOC (M) <br /> Return Permits to: <br /> CCD <br /> P.O. Box 930 <br /> Stockton, CA 95201-0930 <br />