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APPLICATION FOR ENCROACHMENT PERMIT <br /> PLEASE PRINT: l ( Q 2 4 ( 5- <br /> Date <br /> Date ��I2IL OFFICE USE ONLY <br /> To: San Joaquin County JOB# QQ S Z REF# <br /> Department of Public Works APN CR# <br /> EXP. DATES - <br /> VALID g_Z� TO - DRIVEWAYS: <br /> Pacific Comas & Electric STREET <br /> P.O. BOX 930 AREA n QUAD <br /> ( L <br /> TYPE P igr <br /> STOCKTON, CA 95201 FORMSS_ /Vti W <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 /> Cal ifornia supplement <br /> PM 31 v8 q-782 <br /> Notif. <br /> The undersigned hereby applies for permission to excavate, construct and/or otherwise encroach on ounty Highway Right-of-Way on <br /> the side of tr Ave— approximately feet/rdilt- ti4,--54 <br /> of Irft , ,by performing the following work(description of work): <br /> r�cava+� r a- ►" <br /> Work will commence on or about 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 /> Qo'q- \06D aw�u , 17r, 61v-) �Obw' +'�r 94447 <br /> Signature of Applicant-Title Date <br /> EW . MMASTER.PSIENCROACHMENT PERMIT APPLICATION.DOC(01/08) <br /> Return Permits to: <br /> CCD <br /> P.O. Box 930 <br /> Stockton, CA 95201-0930 <br />