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APPLICATION FOR ENCROACHMENT PERMIT <br /> PLEASE PRINT: <br /> Date ���, OFFICE USE ONLY <br /> To: San Joaquin County JOB# ., °7`'3 �1iZ REF# <br /> Department of Public Works APN CR# <br /> EXP.DATE {-(—Zoty <br /> VALIDf0DRIVEWAYS: <br /> Pacific Gas & Electric STREET �� ,tir y ;z <br /> P.O. BOX 930 AREA .51 / QUAD <br /> TYPE _ mac <br /> STOCKTON, CA 95201 FORMSSj <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 d2California supplement <br /> 1��1 t <br /> Notif. <br /> The ndd hereby applies for permission to excavate, construct and/or otherwise encroach on County Highway Right-of-Way on <br /> the 11-- side of Alv approximately ZE715:1- feet/mife 022 <br /> of iswe_ by performing the following work(descri tion of work): <br /> uvrV. W172 Work 1-4tPIn dZ-field 5 g/�4— <br /> Work will commence on or about _for approximately 951L 714 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 /> If <br /> �l <br /> Signature of Applicant-Title Date <br /> E:", . KIMASTER.PSIENCROACHMENT PERMIT APPUCATION.DOC(01/08) <br /> Return Permits to: <br /> CCD <br /> P.O. Box 930 <br /> Stockton, CA 95201-0930 <br />