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APPLICATION FOR ENCROACHMENT PERMIT <br /> PLEASE PRINT: <br /> Date Z� l Fj OFFICE USE ONLY <br /> To: San Joaquin County JOB# 7 (�Q S Z REF# <br /> Department of Public Works APN CR# <br /> EXP. DATE - ( - f 5- <br /> VALID <br /> VALID O -� - �_ DRIVEWAYS: <br /> Pacific Gas & Electric STREET <br /> 11 '40446k— <br /> P.O. BOX 930 <br /> AREA S tpG lC h 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 /> PM ASZ5 California supplement <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 ofQ1 tA DSpP) approximately (per' feet/aNr--4 <br /> of by performing the following work(description of work): <br /> D S a !- <br /> Work will commence on or about for approximately �r'� 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 /> Signature of Applicant-Title ate <br /> EW KIMASTER.PSIENCROACHMENT PERMIT APPLICATION DOG(01108) <br /> Return Permits to: <br /> CCD <br /> P.O. Box 930 <br /> Stockton, CA 95201-0930 <br />