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APPLICATION FOR ENCROACHMENT PERMIT <br /> PLEASE PRINT: <br /> Date OFFICE//Z OFFICE USE ONLY <br /> To: San Joaquin County JOB# REF# <br /> Department of Public Works APN CR# <br /> EXP.DATE / IL <br /> Pacific Gas and Electric Co. VALID to DRIVEWAYS:` <br /> STREET <br /> P.O. Box 930 AREA 4-4 QUAD �Stockton, CA 95201 TYPEjJ <br /> FORMS <br /> NOTES <br /> VL-/ s-sf f <br /> (Area Code-Telephone Number) <br /> Sketch(Detailed plans may be submitted) <br /> Traffic Control Plan <br /> See attached sketch. Shall be as per <br /> PM 301 current M.U.T.C.D. <br /> Notif. California supplement. <br /> The undersigned hereby applies for permission to excavate, construct and/or otherwise encroach on County Highway Right-of-Way on <br /> the N sideof WA1 tk1'(n,2oye /Za, approximately 796feet/mile w <br /> Of /3/0 3 s cNA fZ of 7r , by performing the following work(description of work):- <br /> A0,4 <br /> ork):a s;1---{ 0J Y'Y Y- ly-e '/a r-e— INA) GHS r/C <br /> Work will commence on or about /0 -• Z J— i Z- for approximately.. /15r'0 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 Date <br /> E:IPUB-SV.WKWASTER.PSIENCROACHMENTPERMITAPPLICATION.DOC (01109) <br />