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APPLICATION FOR ENCROACHMENT PERMIT <br /> PLEASE PRINT: <br /> Date ��' � <br /> ---�- OFFICE USE ONLY <br /> To: San Joaquin CountyTV <br /> JOB �3� -� REF <br /> Department of Public Works I AP7NC <br /> _—� <br /> R <br /> EXP. DATE 7r' <br /> P.G. &E. CO. STREDETVALI <br /> 0 t '��v` DRIVEWAYS: <br /> 4040 WEST LANE AREA QUADTYPE 6: <br /> STOCTON, CA 95,204 FORMS �+� <br /> NOTES <br /> I� <br /> (Area Code-Telephone Number) <br /> Sketch (Detailed plans may be submitted) - <br /> Traffic Control Plan <br /> See attached sketch. Shall be as per <br /> PM 307094€'(0 current M.U.T.C.D. <br /> Notif. �o3774G>ZcS' California supplement. <br /> The undersigned hereby applies for permission to excavate, construct and/or otherwise encroach on County Highwa Right-Of-Way on <br /> the F�f'IS'J` 51de Of,�!/ L't�J d <br /> of /t/Cw D approximately_ ? a mile� <br /> by performing the follohling work(description of Work): <br /> �JG ve✓c, .e� 6 �. .�/ �� o u o crG c'eSS Gl/v-r �L� �/ <br /> of <br /> Work wvill commence on or about_ p <br /> for approximately _�� days. <br /> I,the undersigned,certify that I am the owner of the respective property,or am qualified to represeit the owner and agree to do the <br /> work described above in accordance with the rules and regulations of San Joaquin County and sutject to inspection and approval. <br /> ignature of ANrlicant-Title � �� �,� <br /> Date <br /> EIPUB-SV.WKWASicRPS1DICROAC.iMc,%7 PERh9"APPLICATI04.000 (B1100) <br />