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APPLICATION FOR ENCROACHMENT PERMIT <br /> PLEASE PRINT: <br /> Date j J OFFICE USE ONLY <br /> To: San Joaquin County JOB# 130Z"S7 REF# <br /> Department of Public Works APN CR# <br /> EXP.DATE I/ / ) <br /> VALID TO V/IDRIVEWAYS: <br /> Pacif is Gas & Electric STREETp?'*` <br /> P.O. BOX 930 AREA 5���1z1++1 QUAD " <br /> TYPE 11. ri*4 1 <br /> STOCKTON, CA 95201 FORMS ,e <br /> 209-942-1627 NOTES <br /> Sketch(Detailed plans may be submitted) <br /> Traffic Control Plan <br /> shall be as per <br /> See attached sketch. current M.U.T.C.D. <br /> PM -5 Iola 7Z(;� 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 lJDU side of O ' approximately 3o2' feeV;M kle <br /> of 6 -5-1- , by performing the following work(description of work): <br /> O 5 <br /> �J <br /> Work will commence on or about Ir 14, 1-S for approximately go 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 /> \&Oa� , , J" vj � nv� a dl� 11 <br /> Signature of Applicant-Title Date <br /> E:WO . NIMASTERPSIENCROACHMENT PERMIT APPLICATION.00C(01/08) <br /> Return Permits to: <br /> CCD <br /> P.O. Box 930 <br /> Stockton, CA 95201-0930 <br />