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APPLICATION FOR ENCROACHMENT PERMIT <br /> PLEASE PRINT: <br /> Date /G-fl OFFICE USE ONLY <br /> To: San Joaquin County JOB# REF# <br /> Department of Public Works APN CR# <br /> EXP. DATE <br /> VALID (! 25 13 TO 111114 DRIVEWAYS: <br /> Pacific Gas & Electric STREET ba0cCALs Sr, <br /> P.O. BOX 930 AREA �T6 nan6 QUAD <br /> TYPE *.I-(- ROUI— <br /> STOCKTON, CA 95201 FORMS SS w -2,19 <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[ql California supplement <br /> Notif. <br /> The undersigned hereby applies for permission o excavate,construct and/or otherwise encroach on County Highway Right-of-Way on <br /> the side of D 5 approximately (05 feet/mita Wes+ <br /> 0121 C& by performing the following work description of work): <br /> G �s lilla, . Lete ll <br /> Work will commence on or about l 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 /> 0 <br /> ouwu 6w l 1 0 <br /> Signature of Applicant-Title Da <br /> E1PU KIMASTER.PSIENCROACHMENT PERMIT APPLICATION.DOC (0/08) <br /> Return Permits to: <br /> CCD <br /> P.O. Box 930 <br /> Stockton, CA 95201-0930 <br />