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APPLICATION FOR ENCROACHMENT PERMIT <br /> PLEASE PRINT: <br /> Date & I I'l J, Z OFFICE USE ONLY <br /> To: San Joaquin County JOB# 3vb - (o REF# <br /> Department of Public Works APN CR# <br /> EXP.DATE 1 ! 1- <br /> VALID 2 TO S l'Z- DRIVEWAYS: <br /> Pacific Gas & Electric STREET 12D• <br /> P.O. BOX 930 AREA p/ QUAD Al,,� <br /> TYPE <br /> STOCKTON, CA 95201 i FORMS <br /> 209-942-1627 NOTES <br /> { <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 <br /> Notif. <br /> The undersigned hereby applies for permission to excav te,construct and/or otherwise encroach on County Highway Right-of-Way on <br /> the G side of L�/�17� `' approximately : �Co ' feet/mibe <br /> of by performing the following work(description of work): <br /> h ;n <br /> \Work will commence on or about i' for approximately 161Q 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 /> !61 Z <br /> Signature of Applicant-Title ate <br /> E:IP K1MAS7ER.PSIENCROACHMENf P82Mrr APPLICATION.DOC(01108) <br /> Return Permits to: <br /> CCD <br /> P.O. Box 930 <br /> Stockton, CA 95201-0930 <br />