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APPLICATION FOR ENCROACHMENT PERMIT <br /> PLEASE PRINT: <br /> Date 41ZI /1-5 OFFICE USE ONLY <br /> To: San Joaquin County JOB# 73oQ,rj�-(o REF# <br /> Department of Public Works APN CR# <br /> EXP.DATE 1111111 <br /> VALID TO 1111113 DRIVEWAYS: <br /> Pacific Gas & Electric STREET RLAV4-, I I <br /> AREA kMO QUAD 00— <br /> P.O. BOX 930 TYPE ibELL a <br /> STOCKTON, CA 95201 FORMS w P IN <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 ' D <br /> Not if. io6o-700gCo <br /> The undersigned hereby applies for permission to excavate,construct and/or otherwise encroach on County Highway Right-of-Way on <br /> the'J'004.6 side of approximately Z111 feet/ VZJ6-+ <br /> ofXIt% v Vh2"1 , by performing the following work(description of work):N-V-117110 <br /> tau - <br /> Work will commence on or about zs�7 15 for approximately f5p 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 /> .11 <br /> yOyjU V ` 41z'l «� <br /> Signature of Applicant-Title Date <br /> E:IPU MMASTER PSIENCROACHMENT PERMIT APPLICATION.DOC(01/08) <br /> Return Permits to: <br /> CCD <br /> P.O. Box 930 <br /> Stockton, CA 95201-0930 <br />