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APPLICATION FOR ENCROACHMENT PERMIT <br /> PLEASE PRINT: <br /> Date �� OFFICE USE ONLY <br /> To: San Joaquin County JOB# 7.?JoSZZ-Ce REF# <br /> Department of Public Works APN CR# <br /> EXP.DATE <br /> VALID 3 TO // DRIVEWAYS: <br /> Pacific Gas & Electric <br /> STREET <br /> AREA QUAD <br /> P.O. BOX 930 TYPE , Nbk <br /> STOCKTON, CA 95201 FORMS - <br /> 209-942-1627 NOTES Zu <br /> Sketch(Detailed plans may be submitted) <br /> Traffic Control Plan <br /> s hal I be as per <br /> See attached sketch. current M.U.T.C.D. <br /> California supplement <br /> PM 4[&g4g1A- <br /> Notif. lE=&o-70�`v`� <br /> The undersigned hereby applies for erm'ssion to excavate,construct and/or otherwise encroach on County Highway Right-of-Way on <br /> the 600- side of 0 approximately ��� feet/ <br /> of ��S t dl� �ri1 ,by performing the following work(description of work): <br /> ul GUu 1 to' <br /> 23 <br /> Work will commence on or about t for approximately �5v 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 /> E:IPU MMASTER.PSIENCROACHMENTPERWllTAPPLICATION.DOG (01/08) <br /> Return Permits to: <br /> CCD <br /> P.O. Box 930 <br /> Stockton, CA 95201-0930 <br />