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APPLICATION FOR ENCROACHMENT PERMIT <br /> PLEASE PRINT: <br /> Date �'Z�+(2- OFFICE USE ONLY <br /> To: San Joaquin County JOB# 73005 --(a REF# <br /> Department of Public Works APN CR# <br /> EXP.DATE )2- <br /> VALID <br /> 2- <br /> VALID S6 ►L 0 $ t DRIVEWAYS: <br /> Pacific Gas & Electric STREET ,A !?-d ' <br /> AREA QUAD �.;J " <br /> P.O. BOX 930 TYPE 1?E t-cst-rl- " <br /> STOCKTON, CA 95201 FORMS 5s he"Wj r—Z <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 <br /> PM <br /> Notif. 1o56 V 7?j <br /> The undersigned hereby applies for permission to excavate,construct and/or otherwise encro ch on County Highway Right-of-Way on <br /> the kt2-z side of approximately feetfmde6 <br /> of Gam( 1'Li,A by performing the follo ing work(description of work): <br /> u <br /> Work will commence on or about l 2 for approximately 160 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 /> �uwu s 6alu <br /> Signature of Applicant-Title Date <br /> E:IPU KWSTEUSIENCROACHMENTPERMITAPPUCATION.DOC (01108) <br /> Return Permits to: <br /> CCD <br /> P.O. Box 930 <br /> Stockton, CA 95201-0930 <br />