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APPLICATION FOR ENCROACHMENT PERMIT <br /> PLEASE PRINT: <br /> Date It 11-7 OFFICE USE ONLY <br /> To: San Joaquin County JOB# 7 REF# <br /> Department of Public Works APN CR# <br /> EXP.DATE <br /> VALID I-2_1-14 TO Z -(-(S DRIVEWAYS: <br /> Pacific Gas & Electric STREET 6 L'"Iz Quk RA <br /> P.O. BOX 930 AREA / ,�a,, QUAD Al F <br /> TYPE P,QQl_'9lQ <br /> STOC KTON, 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 /> California supplement <br /> PM -351061 <br /> Notif. <br /> The undersigned hereby applies for permission to excavate,co struct and/or otherwise encroach on County Highway Right-of-Way on <br /> the of side of P_ L%Ve- Q V-- approximately [514-1feet/aafe� <br /> of Lw 6U. _, by performing the following work(description of work); <br /> V I r?71 1 5 2{V yz +V On&&2 ho <br /> 2 1 V IG <br /> Work will commence on or about Z S —for approximately e!) 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 /> 1 i <br /> Signature of Applicant-Title bate <br /> E:W KIMASTER.PSIENCROACHMENT PERMIT APPLICATION.DOC (01/08) <br /> Return Permits to: <br /> CCD <br /> P.O. Box 930 <br /> Stockton, CA 95201-0930 <br />