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APPLICATION FOR ENCROACHMENT PERMIT <br /> PLEASE PRINT: <br /> Date �1�,� 65 OFFICE USE ONLY <br /> To: San Joaquin County JOB# 7 REF# <br /> Department of Public Works APN CR# <br /> EXP. DATE OT'j f- /S <br /> VALID -9-4-15 TO 1(L (/S DRIVEWAYS: <br /> Pacif is Gas & Electric STREET <br /> P.O. BOX 930 TRPS ,j Q QUAD _ <br /> STOCKTON, Cil 95201 FORMSSS <br /> 209-942-1627 NOTES �2�� � <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 /> PM 3 I lvv21) California supplement <br /> Notif. <br /> The undersi ned hereby applies for permission to excavate, construct and/or otherwise encroach on County Highway Right-of-Way on <br /> the �Uside of 3�}5 feet/xde� <br /> Of �. l.Jdun�r- PwL G by the following work(description ofwork)-4' x 4 AcG A Afi61C& 4V I'�tacG �g t � Q 5e'J It� a1- 4 O �. •� � <br /> Work will commence on or about for approximately. �Jo 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 Da e <br /> EAP MMASTER.PSIENCROACHMENT PERMIT APPLICATION.DOC (OV08) <br /> Return Permits to: <br /> CCD <br /> P.O. Box 930 <br /> Stockton, CA 95201-0930 <br />