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APPLICATION FOR ENCROACHMENT PERMIT <br /> PLEASE PRINT: <br /> Date 2. 5 OFFICE USE ONLY <br /> To: San-Joaquin County JOB# jQ REF# <br /> Department of Public Works APN CR# <br /> EXP.DATE <br /> VALID [ �3 DRIVEWAYS: <br /> Pac i f is Gas & Electric STREET i <br /> P.O. BOX 930 AREA QUADTYPE � <br /> STOCKTON, CA 95201 FORMS LtlltJ Z l J <br /> 209-942-1627 NOTES All�_141'_ <br /> 'Cv-- <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 /> PM 41664610>5 California supplement <br /> Notif. 1051 e&T 53 <br /> The undersigned hereby applies for permission to excavate,construct and/or otherwise encroach on County Highway Right-of-Way on <br /> the h side of i MA A t approximately A.M.5 feet/ e <br /> of we . ,__���L4P 1 , by performing the following work(description of work): <br /> fafflaAAA A.14, A 4-0 • wof n © o <br /> Work will commence on or about71for approximately �3a 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 /> QLm <br /> Signature of Applicant-Title Date <br /> E:IP( MMASTEPPSIENCROACHMENT PERMIT APPLICATION.DOC (01/08) <br /> Return Permits to: <br /> CCD <br /> P.O. Box 930 <br /> Stockton, CA 95201-0930 <br />