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APPLICATION FOR ENCROACHMENT PERMIT <br /> PLEASE PRINT: <br /> Date l OFFICE USE ONLY <br /> To: San Joaquin County JOB#- 7,9,W-4',Y6 REF# <br /> Department of Public Works APN CR# <br /> EXP.DATE <br /> Pacific Gas and Electric Co. j VALID /' /L TO jZ DRIVEWAYS: <br /> STREET <br /> P.O. BOX 930 AREA yta� QUAD �S <br /> Stockton, CA 95201 TYPE <br /> FORMS �z <br /> NOTES <br /> i <br /> Zoe 141t) <br /> (Area ode-Telephone Number) <br /> Sketch(Detailed plans may be submitted) <br /> Traffic Control Plan j <br /> See attached sketch. Shall be as per <br /> PM current M.U.T.C.D. <br /> Notif. ►p5Z-1`";'(1p- r California supplement. <br /> i <br /> � C o�-t►�L`� t�epJ�"-- <br /> The undersi ned hereby applies for erm'ssion to excgate,construct and/or otherwise encroach on County Highway Right-of-Way on <br /> the side of �,4�lZ)l.l� L�Arlol�i�roximately feeYmile <br /> of ,by performing the followin work(description of work): <br /> s -' o <br /> I lip sr <br /> �Luc�l� E�>>wi P/toJ"�t <br /> Work will commence on or about for approximately <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 /> wor c' ed above in accordance with the rules and regulations of San Joaquin County and subject to inspection and approval.. <br /> S � IZ <br /> Signature of AppPicant-Title Date <br /> CAPUB-SY.WIOMASTERPSIENCROACHMENT PERMIT APPLICATION.DOC (011M <br />