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APPLICATION ;FOR ENCROACHb=T -PERMIT <br /> PLEASE PRINT: .w <br /> o <br /> Date r " DoOFFICE USE ONLY <br /> To: San Joaquin County JOB REF # <br /> Department of Public Works APN Cy # <br /> EXP. DATE <br /> /� <br /> VALID t G' TO 8-/5 O DRIVEWAYS: <br /> PG&E STREET 1�t _UQF_0Rb A\F— <br /> AREAToc "�6►J QUAD <br /> 4040 WEST LANE TYPE ila -F, <br /> FORMS <br /> STOCKTON, CA 95204 NOTE <br /> (City, State, Zip Code) <br /> (DD t �y� -!y9,, <br /> (Area Code - Telephone Number)_ <br /> Sketch (Detailed plans may be submitted) <br /> TRAFFIC CONTROL PLAN <br /> SHALL BE AS PER <br /> CURRENT M.U.T.C.D. 'F <br /> CALIFORNIA 5UPPLEMEN.L��='`�� <br /> SEE ATTACHED SKETCH <br /> PM 3DL l 6 831 <br /> NOTIF: <br /> The undersigned hereby applies for permission to.excavate, .cons.truct and./or <br /> otherwise-encroach cn County -Highway Right-of-Way-ox-the <br /> e9OLI7-,A1 side.-of . <br /> /YMaAlFML /'7L11 . approximately I9L7Z feet/nye Lc�E.Sr <br /> of LJ AW Y 99 FI E X AJr� RD. �TDcKTv�.� by-per€orming the <br /> k__Jdescri prion of work) <br /> CX ZALJW TE IM L L AV,1Z DLJE R v19S Ay7,41._! <br /> r7R�".cr 7D -ZAIS7/4LL IVF/,) L;i9S aS'ErP1 ZeZ <br /> Work will commence on or about for approximately <br /> 90 <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 /> .3 - <br /> %Z-03 <br /> gnature of Applicant -• Title Date <br /> 01 <br /> teasxsx.PS\FESS®L (aloa) RETURN PERMITS TO: <br /> CCD <br /> PG&E <br /> P.O. BOX 930 <br /> STOCKTON,CA 95201 <br />