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APPLICATION FOR ENCROACHMENT PERMIT <br /> vr.F:AsE PRINT: .: <br /> Date 3' - o23 OFFICE US8 ONLY <br /> TO: San Joaquin County JOB # REF # <br /> Department of Public Works APNCR # <br /> EXP. DATE ��- <br /> " i DRIVEWAYS <br /> VALID �� TO � <br /> STREET <br /> PG&E AREA QUAD _A44—V <br /> 4040 WEST LANE TYPE y" p <br /> FORMS 1`S GlrrJ F 'c'S� <br /> STOCKTON, CA 95204 NOTE <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 SUPPLEMENa�- <br /> SEE ATTACHED SKETCH <br /> _C77 <br /> PM 3D 4o/lo3 �? t ,2-el5ls 7r, - i <br /> NOTiF: Io2 6 ,113312— <br /> The <br /> ,113312The undersigned hereby applies for permission to.excavate, construct and/ot <br /> otherwise-encroach on County" ghwa Hi Ri on-the ���T side of <br /> Y g ht-of-W2 Y.. <br /> Cgr_RA/Yl LU7'& kL, approximately _sgSO feet/nadAe nSDurx: <br /> of IM M S7k Al A- ?-h by 'performing the <br /> k__.(desex:.ption of works-: <br /> /-&Z Zu TALL - <br /> Work will commence on ar about for approximately <br /> 3v 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 ru)..es, regulations of San Joaquin County and subject to <br /> inspection and approval.. <br /> S)e. LAS Esr1m1?TDR 3 <br /> gnature of Applicant - Title Date <br /> MASTMA.PS\Vn Cffi1L (6/00) RETURN PERMITS TO: <br /> CCD I <br /> PG&E \ <br /> P.O. BOX 930 <br /> STOCKTON,CA 95201 <br />