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APPLICATION FOR ENCROACHMENT PERMIT <br /> PLEASE PRINT: <br /> Date OFFICE USE ONLY <br /> To: San Joaquin County JOB# REF# <br /> Department of Public Works APN <br /> CR# <br /> EXP.DATE <br /> VALID �! JZ If DRIVEWAYS: <br /> Pacific Gas & Electric STREET u r e, * <br /> P.O. BOX 930 AREA cl a QUAD cog <br /> STOCKTON, CA 95201 TYPE <br /> FORMS w f&2-if <br /> 209-942-1627 i NOTES <br /> Sketch(Detailed plans may be submitted) <br /> Traff is Control Plan <br /> shall be as per <br /> See attached sketch. <br /> current M.U.T.C.p. <br /> PAA'�"Vg5q I;-T6,6, <br /> California supplement <br /> Notif.. i p��j2lve�1 <br /> The undersigned hereby applies for permission to excavate,construct and/or otherwise encroach on County Highway Right-of-W.•a�,on <br /> of side of�� eld approximately�, feetleife s1 <br /> t � l by performing the following work(description of work): <br /> Work will commence on or about 2.. for approximately I <br /> 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 /> `am <br /> Signature of Applicant-Title ` 3 <br /> Date <br /> EP KIMASTERPSIENCROACHMENTPERMRAPPLIC"ON.DOC (01M) <br /> Return Permits to: <br /> CCD <br /> P.O. Box 930 <br /> Stockton, CA 95201-0930 <br />