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,APPLICATION FOR ENCROACHMENT PERMIT <br /> PLEASE PRINT <br /> Date .�f OFFICE USE ONLY <br /> To: San Joaquin County JOB # ?30 S2 -(e REF # <br /> Department of Public Works APN CR # <br /> _ EXP. DATE <br /> } VALID• TO DRIVEWAYS: <br /> (Applicant 'Name) STREET IA0 )sQ 5r. <br /> AREA ffz� QUAD <br /> �� (Y�S� ►/ TYPE <br /> (Mailli�ng Address) FORMS <br /> NOTE <br /> S7�14.dZ/� C TY / 'S �`y' <br /> (City, State, Zip Code) <br /> (Area Code - Telephone Number).. <br /> Sketch (Detailed plans may be submitted) TRAFFIC CONTROL PLAN <br /> SHALL BE AS PER <br /> CURRENT M.U.T.C.D. <br /> CALIFORNIA SUPPLEMENT <br /> RETURN PEF*ArrS To: <br /> PG&E Ap <br /> ,Jog PROCESSM DESK- BLD 1 /az 1347,5.50 <br /> 4wo wed UVW <br /> STOCKTON, CA 96204 <br /> The undersigned hereby applies for permission to.excavate, construct and/or <br /> otherwise-encroach on County.Highway Right-of-Way-on•the,�Yd�M"1r �'S�ttT side of <br /> �cid��T. �.ak9 �LyadS"l.� approximately 17"' ee /ante ��IIST <br /> of X"A ST.14f9 eoe.A by -per€ormiiig the <br /> following work (description of:work) : T1Dawe, Hell `f, O ao rox. <br /> OF atl .W. ox"e, d , j A/ - ii/ g CQ401 <br /> Work will commence on or about for approximately <br /> 4 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 /> Signature os Applicant Title 89 :6 as i 3309 ZDate <br /> MASTSA.PS\F=MML (6/00) <br /> C13A1303,d <br />