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APPLICATION FOR ENCROACHMENT PERMIT <br /> PLEASE PRINT: <br /> Date _ La <br /> OFFICE USE ONLY <br /> To: San Joaquin County JOB# <br /> Department of Public Works �300$�-"�2_ REF# <br /> APN CR# <br /> EXP.DATE / 3 <br /> VALID 4 !_- TO / / DRIVEWAYS: <br /> Pacific Gas & Electric STREET <br /> P.O. BOX 930- AREA s=�QuaD <br /> STOCKTON, CA 95201 TYPE BEtL p�C <br /> FORMS Z9' <br /> 209-942-1627 I NOTES <br /> Sketch(Detailed plans maybe submitted) <br /> Traffic Control Plan <br /> See attached sketch. shall be as per <br /> current M.U.T.C.p. <br /> California supplement <br /> Pm 4-709 <br /> Notif. I olaZZ�z3 <br /> The u dersi ned hereby applies for permission to cc vate, construct and/or otherwise encroach on County Highway Right-of-Way n <br /> the side of -� <br /> of � approximatelyALL, feetlxktp <br /> l by performing the following work(description of work}: <br /> Work will commence on or about <br /> for approximately 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 /> Signature of Applicant-Title 2 <br /> ate <br /> E: KIMASTERPSIENCROACHMENTPBWAPPLICATION.000(01008) <br /> Return Permits to: <br /> CCD <br /> P.O. Box 930 <br /> Stockton, CA 95201-0930 <br />