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I <br /> APPLICATION FOR ENCROACHMENT PERMIT <br /> PLEASE PRINT: <br /> Date 2 Z OFFICE USE ONLY <br /> To: San Joaquin County JOB# f,3G��' —� REF# <br /> Department of Public Works APN CR# <br /> EXP.DATE <br /> VALID 2 TO DRIVEWAYS: <br /> Pacific Gas & EI ectr is STREET !s .4w. <br /> AREA QUAD _ <br /> P.O. BOX 930 TYPE tL <br /> STOCKTON, CA 95201 FORMS <br /> 209-942-1627 NOTES <br /> 144 <br /> 441 2 MI5 kzW <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 <br /> Notif. <br /> The undersig ed hereby applies for permiss.ion to excavate, construct and/or otherwise encroach on County Highway Right-of-Way on <br /> the _6004-1-) side of U). approximately 2,16 feeVmb <br /> Of , by performing the following work(description of work): <br /> Ur <br /> Work will commence on or about for approximately 160 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 /> Signature of Applicant-Title Date <br /> EV MMASTER.PSIENCROACHMENT PERMIT APPLICATION.DOC (01108) <br /> Return Permits to: <br /> CCD <br /> P.O. Box 930 <br /> Stockton, CA 95201-0930 <br />