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APPLICATION FOR ENCROACHMENT PERMIT <br /> PLEASE PRINT: 1 <br /> Date 149-11 A— OFFICE USE ONLY <br /> To: San Joaquin.County JOB# ?j Q 0 SZ REF# <br /> Department of Public Works APN CR# <br /> EXP.DATE 10-31-14 <br /> VALID <br /> - - <br /> VALID 10-14-[¢_ TO DRIVEWAYS: <br /> Pacific Gas & Electric STREAREA S�nr�gq_. QR__�1L_�__— <br /> P.O. BOX 930 <br /> UAD <br /> TYPE gCllhole <br /> STOCKTON, CA 95201 FORMS �s S y✓W RZ� <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 <br /> Notif. <br /> The undersi ned hereby applies for permission to excavate,construct and/or otherwise encroach on County Highway Right-of-Way on <br /> the side of 0Y-IF� 67 approximately q00 feeYw% i <br /> of 1ACP M.-15F- fziP. �ol.l by performing the following work(description of work): <br /> kl r <br /> Work will commence on or about t 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 /> un \0wwu , )y a- f2l 4- <br /> E,IP(1Signature of Applicant-Title ate <br /> 1MASTERPSENCROACHMENT PERMIT APPLICATION.DOG(01108) <br /> Return Permits to: <br /> CCD <br /> P.O. Box 930 <br /> Stockton, CA 95201-0930 <br />