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APPLICATION FOR ENCROACHMENT PERMIT <br /> PLEASE PRINT: <br /> Date blic? OFFICE USE ONLY <br /> To: San Joaquin County JOB# g3005Z.(D REF# <br /> Department of Public Works APN CR# <br /> EXP.DATE Z, '3 <br /> VALID 2? 13 1 13 DRIVEWAYS: <br /> Pacif is Gas & Electric STREET Ws <br /> AREA c'C" QUAD <br /> P.O. eox 930 TYPE p '$cre_ <br /> STOCKTON, CA 95201 FORMsww _2, <br /> 209-942-1627 NOTES <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 /> PM California supplement <br /> Notif. <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 approximately !v? 6:' feet/mft kv5t <br /> of nils d,. , N�U►t , by performing the following work(description of work): <br /> 161 61- to arm <br /> Work will commence on or about 5.11 Z. 3 for approximately t?�c 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 /> \&J � u • /Jrr <br /> y <br /> Signature of Applicant-Title Date <br /> E:IP KIMASTER.PSIENCROACHMENTPERMIT APPLICATION.DOC (01108) <br /> Return Permits to: <br /> CCD <br /> P.O. Box 930 <br /> Stockton, CA 95201-0930 <br />