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APPLICATION FOR ENCROACHMENT PERMIT <br /> PLEASE PRINT: <br /> Date d02� !�. <br /> OFFICE USE ONLY <br /> To: San Joaquin County JOB# ✓ _.O REF# <br /> Department of Public Works APN CR# <br /> EXP.DATE (p (- <br /> VALID 17- iZ 0 co 5- i' DRIVEWAYS: <br /> Pacif is Gas & Electric STREET S' D�, <br /> P.O. BOX 930 AREA QUAD <br /> QUAD $ <br /> STOCKTON, CA 95201 TYPE Ll� t-{O <br /> FORMS <br /> 209-942-1627 NOTES <br /> 7See <br /> ed plans may be submitted) <br /> Traff is Control Plan <br /> shall be as per <br /> ached sketch. current M.U.T.C.D. <br /> PM Co 1,547 California supplement <br /> Noti f. <br /> The undersi ned hereby applies for permission to excavate,construct and/or otherwise encroach on County Highway Right-of-Way on <br /> the side of approximate) <br /> of- �y I��� I �n Y-�-' feet/mile��� <br /> din: <br /> by performing the following work(description of work): <br /> Work will commence on or about �. �. for approximately. &E50 <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 /> Signature of Applicant-Title ` 2 <br /> 1)02-7 Dat <br /> E:IPU K. KIMASTERPSIENCROACHMENr PERMITAPPLICATION.DOC(01/08) <br /> Return Permits to: <br /> CCD <br /> P.O. Box 930 <br /> Stockton, CA 95201-0930 <br />