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APPLICATION FOR ENCROACHMENT PERMIT <br /> PLEASE PRINT: <br /> Date I�' , I+ OFFICE USE ONLY <br /> To: San Joaquin County JOB# REF# <br /> Department of Public Works APN CR# <br /> EXP. DATE <br /> VALID TO DRIVEWAYS: <br /> Pacif is Gas & Electric STREET <br /> P.O. BOX 930 AREA QUAD <br /> TYPE <br /> STOCKTON, CA 95201 FORMS <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 1�5106Z5M7 California supplement <br /> Notif. <br /> The undersigned hereby applies ermission to excavate,construct and/or otherwise encroach on County Highway Right-of-Way on <br /> the f Ian of for approximately feet/mile <br /> f by performing the following work(description of work): <br /> Work will commence on or about L 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 /> Nanuwu . <br /> _Nil /I+ <br /> Signature of Applicant-Title Date <br /> ET - KIMASTER.PSIENCROACHMENT PERMITAPPUCATION.DOC (01/00) <br /> Return Permits to: <br /> CCD <br /> P.O. Box 930 <br /> Stockton, CA 95201-0930 <br />