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APPLICATION FOR ENCROACHMENT PERMIT <br /> PLEASE PRINT: <br /> Date `1411,0,9 OFFICE USE ONLY <br /> To: San Joaquin County JOB �-(,o REF# <br /> Department of Public Works APN CR# <br /> EXP.DATE &11113 <br /> VALID rZ 27 X., TO i,3 DRIVEWAYS: <br /> Pacif is Gas & Electric STREET <br /> AREA QUAD <br /> P.O. BOX 930 TYPE <br /> STOCKTON, CA 95201 FORMS u> -L / "o 11'47 <br /> 209-942-1627 NOTES <br /> Sketch(Detailed plans may be submitted) <br /> Traffic Control Plan <br /> shall be as per <br /> See attached sketch. current M.U.T.C.D. <br /> California supplement <br /> PM 4.,1-74 Z��- <br /> Notif. <br /> The u dersigned hereby applies aZermissiopto excavate,construct and/or otherwise encroach on County Highway Right-of-Way on <br /> the side of � approximately feet _ <br /> of -6/f,L. 2� � G�}- , by performin the following work(description of work): <br /> " D <br /> 2 2 40 6fzrJ2 4Q <br /> Work will commence on or about I 2 2 for approximately 150 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 /> J4 11-5 <br /> Signature of Applicant-Title Date <br /> E:IPU . MMASTER.PSIENCROACHMENT PERMIT APPLICATION.DOC (01/08) <br /> Return Permits to: <br /> CCD <br /> P.O. Box 930 <br /> Stockton, CA 95201-0930 <br />