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APPLICATION FOR ENCROACHMENT PERMIT <br /> PLEASE PRINT: <br /> DateOFFICE USE ONLY <br /> To: San Joaquin County JOB# REF# <br /> Department of Public Works APN CR# <br /> EXP. DATE <br /> VALID ,22 2r,�' TO ±/-&,12- DRIVEWAYS: <br /> Pac i f is Gas & Electric STREET <br /> P.O. BOX 93O AREA 4�--tC� QUAD <br /> TYPE V-A-e <br /> STOCKTON, CA 95201 FORMS S31t � OZ2LF,-1y-e•...(, P21 <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.O. <br /> PM 5115 1 5r- 7 <br /> California supplement <br /> ' <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 of --D. approximately I feet/aft W014 <br /> of—J r►5b V— by performing the following work(description of work): <br /> .4 ' x-A ' r.,?�4A\t&be rA +0 4-v }- Dk4 g&.. 5u"\)t 4f- +V home. -kha.� w t t! lie, <br /> Admol tz4wl AoC iv <br /> Work will commence on or about 2 I for approximately fle-) 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 /> 5 <br /> Signature of Applicant-Title Date <br /> EAPU& . K.TER.PSIENCROACRMENT PERMIT APPLICATION.000 (01/08) - <br /> Return Permits to: <br /> CCD <br /> P.O. Box 930 <br /> Stockton, CA 95201-0930 <br />