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APPLICATION FOR ENCROACHMENT PERMIT <br /> PLEASE PRINT' <br /> OFFICE USE ONLY <br /> Date <br /> JOB# �.�L�?.5�-�D REF# <br /> To: San Joaquin County APN CR# <br /> Department of Public Works EXP.DATE <br /> VALID `' ' I� TO / ! DRIVEWAYS: <br /> STREET ��� 0q V6. <br /> Pac if is Gas & Electric QUAD <br /> AREA S'i��G 'ZZS <br /> P.O. BOX 930 TYPE L PIA <br /> STOCKTON, CA 95201 FORMS e. <br /> 209-942-1627 NOTES <br /> lvll� <br /> Sketch(Detailed plans may be submitted) Traff is Control Plan <br /> shall be as per <br /> See attached sketch. current M.U.T.C.D. <br /> California supplement <br /> PM B�. <br /> Notif. I� Z <br /> hereby applies for permission to excavate,construct and/or otherwise encroach on County Highway feetl�le t-of-Way on <br /> '���. <br /> The undersigned h y pp approximately Zolowing <br /> the �► i-� side of 1 Rl 1 ►P1 �� G . pp,by performing thork(description of work): <br /> of k <br /> �!7'ftiJl-!� <br /> . Work will commence on or about <br /> for approximately days. <br /> ee <br /> I,the undersign ,certifY that I am the owner of the respective property,or am qualified to represent the owner and d ato do al e <br /> work described above in accordance with the rules and regulations of San Joaquin County and subject to inspection p <br /> 4Date <br /> Signature of Applicant-Title <br /> E:1PU KIMASTER.PSIENCROACHM <br /> ENTPERMIT APPLICATION.DOCATION.DOC (07108) Return Permits t0. <br /> CCD <br /> P.O. Box 930 <br /> Stockton, CA 95201-0930 <br />