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APPLICATION FOR ENCROACHMENT PERMIT <br /> PLEASE PRINT: <br /> Dateo OFFICE USE ONLY <br /> To: San Joaquin County JOB# �� �„ REF# <br /> Department of Public Works APN T CR# <br /> EXP. DATE 09 <br /> VALID (0 .5—eP9 TO 0•t5-.,v; DRIVEWAYS: <br /> P.G. &E. CO. STREET Pcsc-K LA. <br /> AREA s�j QUAD -:!9S <br /> 4040 NEST.LANE TYPE <br /> STOCKTON, CA 95204 FORMS <br /> NOTES <br /> ( rea Code•Telephone Number) <br /> Sketch (Detailed plans may be submitted) <br /> Traffic Control Plan <br /> See attached sketch. Shall be as per <br /> PM 3077,51 00 current M.U.T.C.D. <br /> Notif.lv3(fS-Sd 733 California supplement. <br /> S� <br /> The undersigned hereby applies for permissikto excavate, construct and/or otherwise encroach on County Highwa Right-of-Way on <br /> the •25 T' side of— 7C L approximately i Z� a � <br /> of �_€— !�• _by performing the following vdork escription of work): <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 described above in accordance with the rules and regulations of San Joaquin County and subject to inspection and approval.. <br /> Signa re of Applicant 7 itle <br /> Date <br /> EIPUB-SV.WKUAASTER.PSIENCROACHMElr P7MITAPPUCA'PON.000 (01!09) <br />