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APPLICATION FOR ENCROACHMENT PERMIT <br /> PLEASE PRINT: <br /> Date 8I l 1,4— OFFICE USE ONLY <br /> To: San Joaquin County JOB# 773 d 0 5Z REF# <br /> Department of Public Works APN CR# <br /> EXP.DATE (/w� 3 <br /> VALID TO DRIVEWAYS: <br /> Pacific Gas & Electric STREET ---_� At,1`0 <br /> P.O. BOX 930 AREA S+�cto� QUAD <br /> _ <br /> TYPE <br /> STOCKTON, CA 95201 FORMS S SAl W ?�1 <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 �1a8�1o2- <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 5' 4 l?S ' feet/mile KIL::�+ <br /> of LOWY4, ' Un , Vg;��n , by performing the following work(description of work): <br /> u ill G� l <br /> on 1ign <br /> Work will commence on or about for approximately O 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 /> 4Aq &JUWU 6'vv <br /> Signature of Applicant-Title Date <br /> E:1P . KIMASTER.PSIENCROACHMENT PERMIT APPLICATION DOC (01/08) <br /> Return Permits to: <br /> CCD <br /> P.O. Box 930 <br /> Stockton, CA 95201-0930 <br />