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APPLICATION FOR ENCROACHMENT PERMIT <br /> PLEASE PRINT: <br /> Date ��j J S OFFICE USE ONLY <br /> To: San Joaquin County JOB# 7 3,/;Q5'Z REF# <br /> Department of Public Works APN ' CR# <br /> EXP. DATE !` _2� <br /> VALID TO /0-,V DRIVEWAYS: <br /> Pacif is Gas & Electric STREET /Vi f yZo <br /> P.O. BOX 930 AREA ca J QUAD � <br /> TYPE �!et olp <br /> STOCKTON, CA 95201 FORMS �/In <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 b115Z14-I California supplement <br /> Notif. <br /> The undersigned hereby applies for permission to excavate,construct and/or otherwise encroach on County Highway Right-o-Way on <br /> the UO(''1'h side of 5 MSO AVC approximately '%O' feet/ ite I s+ <br /> of P4bw— sLe� by performing the following work(description of work): <br /> ,40 )CA' <br /> Work will commence on or about Zo 5 for approximately 190 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 /> \&J uwu , /J di . <br /> Signature of Applicant-Title Date <br /> E:P MMASTER.PSIENCROACHMENT PERMIT APPLICATIONDOC (01/08 <br /> Return Permits to: <br /> CCD <br /> P.O. Box 930 <br /> Stockton, CA 95201-0930 <br />