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S <br /> APPLICATION FOR ENCROACHMENT PERMIT � " i . . 1, I.' i <br /> nn <br /> PLEASE PRINK'. �i , <br /> Dates ( OFFICE USE ONLY <br /> San-Joaquin_Counfy J0.3.# <br /> Department of Public Works APN CR#. <br /> EXP.DATE l — / — 1 <br /> VALID �-�/ o i _j - DRIVEWAYS; <br /> Pacific Gas and Electric C®, STREET . 9—d'a' * <br /> � J I �5L�A AREA S QUAD <br /> Stockton, CA 95204- TYPE <br /> FORMS /Vy <br /> - NOTES <br /> (Area Code-Telephone Number) <br /> Sketch(Detailed plans may be submitted) 1 <br /> Traffic Control Plan ; <br /> See attached sketch. Shall be as per <br /> PM -�3 1 current M.U.T.C.D. j <br /> Notif. 105JZ1 `°7A- i California Supplement. <br /> I . <br /> Please return permit to: <br /> CCD Desk <br /> 040 West Lane <br /> Stockton, CA 95204 <br /> The undersigned hereby applies for ermission to xcavate.construct and/or otherwise encroach on County Highway Right-off-Way on <br /> the Or /l f side of _ L _approximately �J Z-. "-3 feethw& <br /> of ate_,by performing the following work(description of wbrk): <br /> 0 vaza Ur LD <br /> Work will commence on or about for approximately days. <br /> 1,the undersi ned, certify.that I am the owner of the respective property,or am qualified to represent the owner and agree to do the <br /> wor crib above in accordance with the rules and regulations of San Joaquin County and subject to inspection and approval., <br /> w <br /> Signature of Applicant_ itle � Date <br /> 1PUB-SV.WNIMASTERPStENCROACHIAENTPERMITAPPLICATl� 09J E � <br /> Please return permit to: <br /> CCD Desk <br /> 4040 West Lane <br /> Stockton,CA 95204 <br />