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APPLICATION FOR ENCROACHMENT PERMIT <br /> PLEASE PRINT: <br /> Date g l 12 OFFICE USE ONLY <br /> To: San Joaquin County JOB# , REF# <br /> Department of Public Works APN CR# <br /> EXP.DATE <br /> VALID TDRIVEWAYS: <br /> Pac i f is Gas & Electric STREETu79 V'* <br /> AREA -557V.:.- 3d QUAD <br /> P.O. BOX 930 TYPE -sliGc,Nev_�— <br /> STOCKTON, CA 95201 FORMS iJIV <br /> ✓lt/, <br /> 209-942-1627 NOTES <br /> Sketch(Detailed plans may be submitted) <br /> Traff is Control Plan <br /> s hal I be as per <br /> See attached sketch. current M.U.T.C.D. <br /> California supplement <br /> PM ', 1,49547 <br /> Notif. <br /> The undersigned hereby applies for permission to excavate,construct and/or otherwise encroa h on County Highway Right-of-Way on <br /> the 6-3 side of ` U approximately feet/ <br /> of , by performing the following work(description of work): <br /> 64010 <br /> U.)0CV:n 6!QM OL�__bA' al-to I iz ?zxn/wj4W Pw u)a An 4p" l ltw <br /> Work will commence on or about for approximately 18Q 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 /> \Oyj t <br /> C� W� tZ 12 <br /> Signature of Applicant-Title Date <br /> E:IPU . MMASTER.PSIENCROACHMENTPERMIT APPLICATION.DOC (01/08) <br /> Return Permits to: <br /> CCD <br /> P.O. Box 930 <br /> Stockton, CA 95201-0930 <br />