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APPLICATION FOR ENCROACHMENT PERMIT <br /> PLEASE PRINT: <br /> Date �� ` OFFICE USE ONLY <br /> To: San Joaquin County JOB# REF# <br /> Department of Public Works APN CR# <br /> EXP.DATE )j t <br /> VALID TO DRIVEWAYS: <br /> Pacific Gas & Electric <br /> STREET 1VJ4 .41� <br /> AREA QUAD e,C <br /> P.O. BOX 930 TYPE -a6dI�LS <br /> STOCKTON, CA 95201 FORMS �r 7 <br /> 209-942-1627 NOTES dr 1 <br /> Sketch(Detailed plans may be submitted) <br /> Traff is Control Plan <br /> s hal I be as per <br /> See attached sketch. current M.U.T.C.D. <br /> California supplement <br /> PM 41&1+�&7 <br /> Not i f.The undersigned undersigned hereby applies for permission to excavate,construct and/or otherwise encroach on County Highway Right-of-Way on <br /> the kh side of Chri b1h oto, approximately 06 4 10' feet�mHe 4- <br /> of 6 icy— 6 , by performing the following work(description of work): <br /> <� I� at) <br /> Work will commence on or about A13oli,5 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 /> unS <br /> Signature of Applicant-Title Date <br /> E:IPu . KIMASTER.PSIENCROACHMENTPERMIT APPLICATION.DOC (01/08) <br /> Return Permits to: <br /> CCD <br /> P.O. Box 930 <br /> Stockton, CA 95201-0930 <br />