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APPLICATION FOR ENCROACHMENT PERMIT <br /> PLEASE PRINT: <br /> Date Z.,' �° ;'` <br /> OFFICE USE ONLY <br /> To: San Joaquin County JOB# ? �, REF# <br /> Department of Public Works APN CR# <br /> EXP.DATE <br /> VALID ?./6.e9 TO /D DRIVEWAYS: <br /> P.G. &E. CO: STREET Ft'i to L57 awff�' <br /> 4040 WEST LANE AREA sTc 1 QUAD W� ` <br /> TYPE XX, c <br /> STOCKTON, CA 95204 FORMS `35 W, 2.9 <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 � '7 7 -;% current M.U.T.C.D. <br /> Notif. /- h� , -7; �,( California supplement. <br /> I <br /> The undersigned hereby applies-for permission to excavate, construct and/or otherwise encroach on County Highway Right-of-Way on <br /> the r xft5 side of__. approximately_ "� <br /> 01 <br /> by performing the follo)r,ing work(description of work): <br /> r F _5 1221)d 2:�, r <br /> Work will commence on or about for approximately z 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 /> Signature of Applicant-Tide '/ Date <br /> E1PUB-SV.WKUAFSTERPSIENCROAG9MEMP�-RMfTAPPLICATON.000 (0110B) <br />