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APPLICATION FOR ENCROACHMENT PERMIT <br /> PLEASE PRINT: C� <br /> Date �A'Q, . 3 Zc�c� ) OFFICE USE ONLY <br /> To: San Joaquin County JOB# `l 110o!5-4- REF# <br /> Department of Public Works APN CR# <br /> EXP. DATE rl•!5--a5 <br /> VALID ' g•o TO 7.1s,d ? DRIVEWAYS: <br /> P G. &E. CO. STREET A0IIWA;1rg e .� <br /> AREA 57ae*raW QUAD <br /> 4040 WEST LANE TYPE HbLE <br /> STOCKTON, CA 95204 FORMS s�5/� ✓w� Q zg <br /> NOTES <br /> ��-2 - 14Z� <br /> (Area Code-Telephone Number) <br /> Sketch (Detailed plans may be submitted) <br /> `EE::* AZT-�'C-D Traffic Control Plan <br /> See attached sketch. Shall be as per <br /> PM3p�Q�tjp5 current <br /> - ` M.U.T.C.D. <br /> Notif.(p3"1i supplement.ent. <br /> The undersigned hereby applies f r permission to excavate, Istruct and/or otherwise encro ch on C4ounty Highway Right-of-Way on <br /> the side of approximately t�' feet/ <br /> of LCL . ft.71794Mhl by performing the following work(description of work :- <br /> 6 e <br /> 1 <br /> Work will commence on or about for approximately 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 /> cribed above in accordance with the rules and regulations of San Joaquin County and subject to inspection and approval. <br /> Signature of pplicant-Title Date <br /> E:iPNB-SV.WKIMASTERPSIENCROACHMENT PERMIT APPLICATION.DOC (01MB) <br />