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APPLICATION FOR ENCROACHMENT PERMIT <br /> PLEASE PRINT: <br /> Date i 2 IJ OFFICE USE ONLY <br /> To: San Joaquin County JOB# REF# <br /> Department of Public Works APN CR# <br /> EXP.DATE l� <br /> VALID 3 0 j/ ,3 DRIVEWAYS: <br /> Pacif is Gas & Electric STREET <br /> P.O. BOX 930 AREA /y QUAD <br /> TYPE <br /> STOCKTON, CA 95201 FORMS <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 /> PM �j 8 �7 2�� <br /> Notif. I cCv-7Z2&0-- <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 T:>ury-A,ri approximately 2 t feet/r Ie_ cam <br /> of Flo , by performing the following work(description of work): <br /> �x I ho 5 ce sh <br /> 3 <br /> r <br /> Work will commence on or about for 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 /> � o <br /> Signature of Applicant-Title Date <br /> E:IPUb KIMASTER.PSIENCROACHMENTPERMITAPPLICATION.DOC (01/08) <br /> Return Permits to: <br /> CCD <br /> P.O. Box 930 <br /> Stockton, CA 95201-0930 <br />