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AppLICATIOPT FOR. ENCROACINT PERMIT <br /> LEASE PRINT:. , <br /> OFFICE.IISS ONLY <br /> %2 <br /> 20 - Cd <br /> Date z e; Z i REF # <br /> JOB CR # <br /> To: San Joaquin County APN <br /> Department of Pub-' is Works EXP DATE I_ <br /> VALID ? ` 7 o sea TO Q-l S_c-T DRIVggIAYS <br /> i <br /> STREET XJ r� A� e_' -- <br /> PG&E QUAD <br /> TYPE ► ''_ff' ------ <br /> 4040 WEST LANE FORMS ��v <,. <br /> STOCKTON, CA 95204 <br /> NOTE <br /> (City. State, Zip Code) <br /> D I y 9� <br /> (Area Code Telephone Number) . <br /> be submitted) TRAFFIC CONTROL PLAN <br /> F(DITied plans, mai' SHALL BE AS PER <br /> L > <br /> CURRENT M.U.T.C.D. <br /> CALIFORNIA SUPPLEMEN-C.T' <br /> HED SKETCH <br /> PM <br /> MOTIF 04 <br /> d hereby applies for permission to.excavate, construct side-5.6f <br /> The undersigned oa-the Borll.. - <br /> Ri ht-of-Way <br /> - - Hi hway g ���- feet/cue <br /> otherwise encroacf. on County approximately b -vy erf-ormirig the <br /> of So.vv/26a oS,7, <br /> 5cription-of_wo �Lsv zu<7'�9i i <br /> /3l�lZC U[ c1/L//[� /J t�C /z_) <br /> Gr�n/i/�Ci .�E� 7%F/G� T� /�L/P- !`��LL �J�1v�l[_. <br /> Z�c �_�,J _-L roximately <br /> for app <br /> Work will commence on or about <br /> i L' days. <br /> ro erty, or am <br /> I, the undersigned certify that I am the owner of. the respective p P <br /> in County and subject to <br /> qualified to represent the owner and agreeto <br /> doathe work described above in <br /> accordance with the :rules, regu <br /> lations o <br /> inspection and approval. <br /> - aS2. Isf9aS' E�9'llY1Y1TDR Date <br /> t - Title <br /> Applicant 7 <br /> Agnature of APP <br /> M,,THR.HB\FMS®L WC10) RETURN PERMITS TO: - <br /> CCD � <br /> PG&E <br /> P.O. BOX 930 <br /> STOCKTON,CA 95201 <br />