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APPLICATION FOR ENCROACHMENT PERMIT <br /> PLEASE PRINT: <br /> Date q/Z 6 //2- OFFICE USE ONLY <br /> To: San Joaquin County JOB# REF# <br /> Department of Public Works APN CR# <br /> EXP.DATE S <br /> VALID =02,--112- /$ DRIVEWAYS: <br /> Pacific Gas and Electric Co. STREET <br /> P.O. Box 930 AREA tl;e V QUAD <br /> Stockton, CA 95201 TYPE LL!/2�6 <br /> FORMS � IW ,e-ZS <br /> NOTES <br /> Z01 - gtIZ -' iSq� <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 currentM.U.T.C.D. <br /> Notif. .5�55 California supplement. <br /> The undersigned hereby applies for permission to excavate, construct and/or otherwise encroach on County HighwRight-of-Way on <br /> the side of W• L AI?c 14 2 D- approximately 2-6 �5— fee mile W <br /> of T V- 'q C' L- V D _ �+' , by performing the following work( escn tion of work): <br /> Ex(-,ay,a �� �� <br /> Work will commence on or about /5 ✓a/ iZ for approximately o 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.WKMSTERPSIENCROACNMEMPERMITAPPUCATION.DOC (01/08 <br />