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APPLICATION FOR ENCROACHMENT PERMIT <br /> PLEASE PRINT: <br /> I <br /> Date OFFICE USE ONLY <br /> To: San Joaquin County JOB# REF# <br /> Department of Public Works APN CR# <br /> EXP.DATE <br /> VALIDIt'*Zv •.v TO g • •©j DRIVEWAYS: <br /> P.G. &E. CO. STREET <br /> 4040 WEST LANE AREA s,-C,�, QUAD 55 i <br /> TYPE <br /> �4 rt <br /> STOCKTON, CA 95204 FORMS 55 ✓,ry a <br /> NOTES <br /> (Area Code-Telephone Number) <br /> Sketch(Detailed plans may be submiSEiE <br /> tted <br /> Traffic Control Plan <br /> See attached sketch. Shall be as per <br /> PM 507,_�>ycurrent M.U.T.C.D. <br /> Notif.!, California supplement. <br /> The undersigned hereby applies fDr permis on to excavate,con truct and/or otherwise encroach on Cpunty Highway Right-of-Way on <br /> the side of C - j "�7�� , approximately t` feetLaz�_— <br /> of b erformin <br /> 7 . p g the following work(description of work): <br /> pr <br /> + in <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 /> work.des cribed above in accordance with the rules and regulations of San Joaquin County and subject to inspection and approval.. <br /> Signature o—'f Applicant-Title <br /> Dat <br /> E:IPU&SV.WMMASTEPPSIENCROACP.MENTPERMITAPPLICATION.DOC (01108) <br />