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APPLICATION FOR ENCROACHMENT PERMIT <br /> PLEASE PRINT: <br /> Date w1-zz 1I;D • OFFICE USE ONLY <br /> To: San Joaquin County JOB# ?, �(a REF# <br /> Department of Public Works APN CR# <br /> EXP. DATE / —3 <br /> VALID to / / 13 DRIVEWAYS: <br /> Pacific Gas & Electric STREET Awy&l <br /> P.O. BOX 930 AREA r �c,�6,,J QUAD �(I$ <br /> TYPE <br /> .STOCKTON, CA 95201 FORMS ss s✓�y��l�� K o �c� <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 4 1,1&9 Ll 5 Cal ifornia 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 _11�001JH side of K-e_11y00 approximately LSC) feet/04e � <br /> of on _, by performing the following work(description of work): <br /> G w 4v - orV- a2, to Z C <br /> Work will commence on or about 10.1,z �b for approximately '7 days. <br /> 1,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 —mate <br /> E:IPD . IAMASTER.PSIENCROACHMENT PERMIT APPLICATION.DOC(01/08) <br /> Return Permits to: <br /> CCD <br /> P.O. Box 930 <br /> Stockton, CA 95201-0930 <br />