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APPLICATION FOR ENCROACHMENT PERMIT <br /> PLEASE PRINT: <br /> Date w 1 6CT" OFFICE USE ONLY <br /> To: San Joaquin County JOB# gyp , _�, REF# <br /> Department of Public Works APN CR# <br /> EXP.DATE <br /> Pacific Gas and Electric Co. VALID pq TO I. e---.o DRIVEWAYS: <br /> P.O. BOX 930 STREET <br /> AREA !tee +�( QUAD <br /> Stockton, CA 95201 TYPE OLE <br /> FORMS <br /> NOTES <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 � t <br /> 7o°��7 current M.U.T.C.D. <br /> Notif. lam California supplement. <br /> The unudersicIned hereby applies for p rmission to excavate,construct and/or oth <br /> the side of erwise encroa hon County Highway Right-of-Way on <br /> of —�approximately Z4 feet/FML- 1,►+ <br /> by performing the following work(description of work): <br /> Work will commence on or about— for approximately <br /> days. <br /> y <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 /> Signature of Applicant-Title ate <br /> B-SV.WKWVSTERPSIENCROACNMENTPERMITAPPUCATIONOOC (010) <br /> Return permits to: <br /> CCD <br /> P.O. Box 930 <br /> Stockton, CA 95201-0930 <br />