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APPLICATION FOR ENCROACHMENT PERMIT <br /> PLEASE PRINT: 0 W 5 <br /> Date �� OFFICE USE ONLY <br /> To: San Joaquin County JOB# REF# <br /> Department of Public Works APN CR# <br /> EXP. DATE <br /> VALID I Z�3 TO * DRIVEWAYS: <br /> Pacific Gas & Electric STREET 5eC-tj&Aypf,(2[1 vP_ ,6Ve- <br /> P.O. BOX 930 AREA 4, � QUAD <br /> TYPE <br /> STOCKTON, CA 95201 FORMS -2.c39I�0 <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 /> California supplement <br /> PM�1a3821 I <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 feet/mile <br /> of by performing the following work(description of work): <br /> I�- <br /> Work will commence on or about /3 for approximately 5 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 /> un \06D UWU �Obn'v+�r <br /> Signature of Applicant-Title bate <br /> E:IP . MMASTER.PMENCROACHMENT PERMIT APPLICATION.DOC(01108) <br /> Return Permits to: <br /> CCD <br /> P.O. Box 930 <br /> Stockton, CA 95201-0930 <br />