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APPLICATION FOR ENCROACHMENT PERMIT <br /> PLEASE PRINT: <br /> Date OFFICE USE ONLY <br /> To, San Joaquin County JOB REF# <br /> Department of Public Works APN CR# <br /> EXP.DATE / /3 <br /> VALID Z /3 0 / /3 DRIVEWAYS: <br /> Pacific Gas & Electric <br /> STREET <br /> P.O. BOX 930 <br /> AREA f ` QUAD <br /> TYPE <br /> STOCKTON, CA 95201 FORMS ,�- <br /> 209-942-1627 NOTES <br /> Sketch(Detailed plans may be submitted) <br /> Traff is Control Plan <br /> shall be as per <br /> See attached sketch. current M.U.T.C.D. <br /> California supplement <br /> Notif. ea633355�5 <br /> The undersigned hereby applies for permission.to excavate,construct and/or otherwise encroach on County Highway Right-of-Way on <br /> the E:*- �A side of approximately 16E�o feet/ <br /> of M2r"4.A0' f3t ��,� , by performing the following work(description of work): <br /> . x r <br /> ev'libowz 0))4L j-41&26 nal � <br /> Work will commence on or about Z for approximately l 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 /> \OW a., " , <br /> Signature of Applicant-Title Dare <br /> E:IPU KIMASTER PSIENCROACHMENi PERMIT APPLICATION.DOC (01/08) <br /> Return Permits to: <br /> CCD <br /> P.O. Box 930 <br /> Stockton, CA 95201-0930 <br />