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APPLICATION FOR ENCROACHMENT PERMIT <br /> PLEASE PRINT: <br /> Date ���I OFFICE USE ONLY <br /> To: San Joaquin County JOB# '7 REF# <br /> Department of Public Works APN CR# <br /> EXP.DATE 7 /S IZ- <br /> 11 <br /> VALID ! 3 TO. /S� DRIVEWAYS: <br /> Pacif is Gas & Electric STREETAy— <br /> P.O. BOX 930 AREA -q9V&4k*A1 QUAD w5 <br /> TYPE GiEdG hrat.E <br /> STOCKTON, CA 95201 FORMS z,4,u ,e-z-F <br /> 209-942-1627 NOTES <br /> - - I <br /> Sketch(Detailed plans may be submitted) <br /> Traffic Control Plan <br /> shall be as per <br /> See attached sketch. current M.U.T.C.b. <br /> Cal ifornia supplement j <br /> PM ---56:957652,Z <br /> Notif. 1v54--31 2, 7 <br /> The unde si ned hereby applies for permission to excavate,construct and/or otherwise encroach on County Highway Right-of-Way on <br /> the !:-5side of o A— / - approximately feeVm#e 1 <br /> of ,by performi he f Ilowing work(description of work): <br /> A <br /> `Work will commence on or about for approximately T 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 I date <br /> E:1P11 81ENCROACHMENTPERWAPPUCKnORDOC(01108) <br /> Return Permits to: <br /> CCD <br /> P.O. Box 930 <br /> Stockton, CA 95201-0930 <br />