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APPLICATION FOR ENCROACHMENT PERMIT <br /> PLEASE PRINT: <br /> Date Ll OFFICE USE ONLY <br /> To: San Joaquin County JOB#- VW5 01 REF# <br /> Department of Public Works APN CR# <br /> EXP.DATE rlatw i I <br /> VALID 2 22 1 t 0 KAJ J3 DRIVEWAYS: <br /> Pacif is Gas & Electric STREET IL��nl <br /> L a <br /> P.O. BOX 930 � AREA QUADTYPE <br /> STOCKTON, CA 95201 FORMS Al <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. <br /> The undersigned hereby applies for,permission to excavate,construct and/or otherwise encroach on County Highway Right-of-Way on <br /> the side of 150 LD t1l approximately feet/caRe�•o �t4 <br /> ofi ��G�fi_ , by performing the following work(description of work): <br /> -4 eoa <br /> Work will commence on or about - S for approximately 050 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 /> un, <br /> Signature of Applicant-Title Dat <br /> E:T MMASTER.PSIENCROACHMENiPERMIT APPLICATION.DOC (01/08) <br /> Return Permits to: <br /> CCD <br /> P.O. Box 930 <br /> Stockton, CA 95201-0930 <br />