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APPLICATION FOR ENCROACHMENT PERMIT <br /> PLEASE PRINT: <br /> Date /Z U ! OFFICE USE ONLY <br /> To: San Joaquin County JOB# REF# <br /> Department of Public Works APN CR# <br /> EXP. DATE ./ . 00 <br /> Pacific Gas and Electric Co: VALID TO DRIVEWAYS: <br /> STREET <br /> P.O. Box 930 AREA �_ QUAD <br /> yp �7G4 <br /> Stockton, CA 95 TYPE FORMS s w <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 3'U7¢004c, current M.U.T.C.D. <br /> Notif.la4 2 7 California supplement. <br /> The undersigned hereby applies for per fission to excav� construct and/or otherwise encroach on County Highway Right-of-Way on <br /> theuJesT4€,o��side ofP approximately 3 c ee file ` v <br /> of n/ c by performing the following work escription of work): <br /> z�r �J c/JVC' ! �/ F L7 r r N �/�rte:, r/ �X �i7 5 '✓/Y /CL?. <br /> 4 5 5<- C V 4 ZS r,"r?c r <br /> J <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 /> Signature of Applicant-Title D to <br /> EVUB SVAKWASTER.PSIENCROACHMENT PERMIT APPLICATION.DOC (01108) <br />