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APPLICATION FOR ENCROACHMENT PERMIT <br /> PLEASE PRINT: <br /> Date OFFICE USE ONLY <br /> To: San Joaquin County JOB# 'y3do52-(a REF# <br /> Department of Public Works APN CR# <br /> EXP. DATE 3 <br /> Pacific Gas and Electric Co. VALID 0 DRIVEWAYS: <br /> STRE <br /> P.O. Box 930 AREAETr� QUAD <br /> Stockton, CA 95201 TYPE <br /> FORMS �Z"7 <br /> NOTES <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 y/ 77-IV-Tl/ current M.U.T.C.D. <br /> Notif. lob 2 7,733y California supplement. <br /> The undersigned hereby applies for permission to excavate, constructand/or otherwise encroach on County Highway Right-of-Way on <br /> the .Sour/ ,/ side of jgL-1 AJ Ljjf: approximately. S feet/Riile LJES1' <br /> of F?ft c/K C' , 4060LAO e'-,�r , by performing the following work(description of work): <br /> sit q4-A, 441E . <br /> 2EPL1-7Cc CuRl3 411.6 771,47"' t��� �PE/�7avEt7 To <br /> Work will commence on or about /O-3i-/2 for approximately 5;v 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 /> a. G/aS A i� E <br /> Signature of Applicant-Title Date <br /> E'PUB-SV.WKVAASTER.PSIENCROACHMENT PERMIT APPLICATION.DOC (07/08) <br />