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APPLICATION FOR ENCROACHMENT PERMIT <br /> PLEASE PRINT: <br /> Date 4h5 15 OFFICE USE ONLY <br /> To: San Joaquin County JOB# 7 300 REF# <br /> Department of Public Works APN CR# <br /> EXP. DATE <br /> VALID DRIVEWAYS: <br /> Pacific Gas & Electric STREET <br /> P.O. BOX 930 AREA Z_Q�_ QUAD — <br /> TYPE ae4( ) <br /> STOCKTON, CA 95201 FORMS 55 <br /> 209-942-1627 NOTES <br /> Sketch(Detailed plans may be submitted) <br /> Traff is Control Plan <br /> shall be as per <br /> See attached sketch. current M.U.T.C.D. <br /> 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 WW side of AA-Mr to"E> S1r approximately 20' feeVm#e :511F <br /> of 5L.M �f LcGI���-t,FS p by performing the following work(description of work): <br /> Xca,Ya� ' K icn i � 1 v fie � 3 51. <br /> t r <br /> Work will commence on or about 4/1-2/15 for approximately 19 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 /> Y <br /> Signature of Applicant Title Date <br /> E9P . MMASTER.PSIENCROACHMENT PERMIT APPLICATION.DOC (01/08) . <br /> Return Permits to.- <br /> CCD <br /> o:CCD <br /> P.O. Box 930 <br /> Stockton, CA 95201-0930 <br />