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r <br /> r <br /> I . <br /> APPLICATION FOR ENCROACHMENT PERMIT <br /> PLEASE PRINT: <br /> Date —iAr Vz OFFICE USE ONLY <br /> To: San-Joaquin County -JOB# - Y 0157 REF.# - <br /> Department of Public Works APN CR# <br /> EXP.DATE 7/1/6 <br /> VALID 1 TO )' DRIVEWAYS: <br /> Pac i f is Gas & Electric STREET )rzle e ve <br /> AREA �dGL"� QUAD <br /> P.O, BOX 930 TYPE � Pt <br /> ST4CKT4f�1, CA 95201 FORMS? o I <br /> 209-942-1627 NOTES orof <br /> -/ <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 /> Not if.1t;&5895ol5 <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 tA I( jEf AkVe. approximately 10' feet/rk4154-t4- <br /> of , b performing the following work(description of work): <br /> 1U11112.. <br /> Work will commence on or aboutfor approximately 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 /> 4Aq 661'_-2 <br /> Ik I <br /> Signature of Applicant-Title Date <br /> E:IP . KIMASTER.PSIENCROACHMENT PERMIT APPLICATION.DOC(01/08) <br /> Return Permits to: <br /> CCD <br /> P.O. Box 930 <br /> Stockton, CA 95201-0930 <br />