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APPLICATION FOR ENCROACHMENT PERMIT <br /> PLEASE PRINT: <br /> OFFICE USE ONLY <br /> Date � <br /> 7 �Z^� <br /> To: San Joaquin County JOB # REF #CR # <br /> Department of Public Works APN <br /> EXP_ DATE <br /> VALID 11-12-OC TO ot 3-fl-0 DRIVEWAYS: <br /> (Applicant Name) STREET �S <br /> l. / AREAS QUA <br /> TYPE <br /> (Mailing Address) FORMS® , <br /> NOTE <br /> n <br /> (City, State, Zip Code) <br /> ) ,:IA2 . i6v2-1 <br /> (Area Code - Telephone Number) <br /> Sketch (Detailed plans may be submitted) TRAFFIC CONTROL PLAN <br /> SHALL BE AS PER c ,'% <br /> CURRENT M.U.T.C.D. r" C:, <br /> CALIFORNIA SUPPLEMENT <br /> r— CYN =rn <br /> Ev —z:z <br /> U <br /> The undersigned hereby applies for permission to excavate, nsttruct and/or <br /> side o <br /> thrwise encroach o County Highway Right-of-Way on the feet/rt�iwirs <br /> approximately <br /> ti by perfor ing the <br /> of PP <br /> f llgwing work de cription of work) rn: <br /> r <br /> Work w' 11 commence on or about <br /> q_� f��__ _ for approximately <br /> — days <br /> I, the undersigned certify that I am the owner of the respective property, or am <br /> qualified to represent the owner and agree to do the work described above in <br /> accordance with the rules, regulations of San Joaquin County and subject to <br /> inspection and approval. <br /> a1 <br /> —*e <br /> raturefApplicant - Title RMTLJFiPt PERMITS TO: <br /> (-./GO) PG&E. <br /> JOB PROCES3M DESK- BLD 1 <br /> 4040 Wed LWW <br /> STLVA\rON, OM1 95204 <br />