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APPLICATION FOR ENCROACHMENT PERMIT <br /> PLEASE PRINT: <br /> Date OFFICE USE ONLY <br /> To: San Joaquin County JOB#- ,.3Go�� REF-#. .. - - - - - -- <br /> Department of Public Works APN CR# <br /> EXP.DATE 5 �� <br /> VALID TO IS 13 DRIVEWAYS: <br /> Pacif is Gas & Electric STREET � <br /> AREA a•�/ QUAD <br /> P.O. Box 930 TYPE o� <br /> STOCKTON, CA 95201 FORMS <br /> 209-942-1627 ' NOTES 6 <br /> �►�YIE <br /> Sketch(Detailed plans may be submitted) <br /> Traf f is Control Plan <br /> shall be as per <br /> See attached sketch. current M.U.T.C.D. <br /> PIN <br /> Cal ifornia supplement <br /> �������8 <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 .7OL4-h side of approximately_?A feet/n� (� <br /> of��ra•I1 z by performing the following work(description of work): <br /> Work will commence on or about !-!!�I 1115 for approximately �'!:b days. <br /> 117 <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 /> \0W4wu r <br /> Signature of Applicant-Title Date <br /> EAP . MMASTERPMENCROACHMENTPERMITAPPLICATION.DOC(01108) <br /> Return Permits to: <br /> CCD <br /> P.O. Box 930 <br /> Stockton, CA 95201-0930 <br />