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APPLICATION FOR ENCROACHMENT PERMIT <br /> PLEASE PRINT: <br /> Date e-I I6oI 14 OFFICE USE ONLY <br /> To: San Joaquin,County JOB# 7300S REF# <br /> Department of Public Works APN CR# <br /> EXP.DATE 1 - <br /> VALID 10 -(p- TO (J -31-If DRIVEWAYS: <br /> Pacific Gas & Electric STREET 5 2Hcimu,�v <br /> P.O. BOX 930 AREA Jo y 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 /> Cal ifornia supplement <br /> PM �J1 to ZL�S <br /> Notif. <br /> The u dersig ed hereby applied f permission to excavate,construct and/or otherwise encroach on County Highway Right-of-Way on <br /> the side of w 60no approximately 610'7 ' feet/ Weii5+ <br /> of _, by performing the following work(description of work): <br /> c� tea>� Wdrlk- 4omale-�# OlJSSI0- <br /> Work will commence on or about _for approximately !1 Q 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 /> E:IP(ISignature of Applicant-Title Date <br /> MASTERPSIENCROACHIVENT PERMIT APPLICATION.DOC (01108) <br /> Return Permits,to: <br /> CCD <br /> P.O. Box 930 <br /> Stockton, CA 95201-0930 <br />