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APPLICATION ;FOR ENGROACHI�lENT :PERMIT <br /> PLEASE PRINT; , <br /> Date ,� - OFFICE, USE ONLY <br /> TC: San Joaquin County JOB # 7�/ J5 -� REF <br /> Department of Public Works APN CR # ' <br /> EXP. DATE <br /> VALID.. 6-7-4)0_ '.TO 7'/S,08 DRIVEWAYS <br /> PG STREET <br /> &E <br /> x <br /> AREA pro QUAD <br /> .TYPE <br /> 4040 WEST LANE FORMS5 ��w . 'i2l <br /> STOCKTON, CA 95204 NOTE <br /> (City, State, .Zip Code) <br /> (Area Code - Telepho=ne Number)... <br /> Sketch (Detailed plans may be submitted) TRAFFIC CONTROL PLAN <br /> SHALL BE AS PER <br /> CURRENT M.U.T.C.D. �s <br /> CALIFORNIA 5UPPLEMEN.L�, <br /> SEE ATTACHED SKETCH <br /> PM <br /> NOTIF: �iy1 3DB z <br /> The undersigned hereby applies for permission to.excavate, construct and../or <br /> otherwise-encroach on County-Highway. Right-of-Way--oa-the AS-r, side.-of <br /> •19LZA 25 ST approximately feet/fie o$041rY <br /> of m.-3R�E STQea': '04/` +. }�y-performing the A <br /> _ __ follarKing.�rszxk-1s .Ption of:workZ Jam/ deT�E2 T 2�151's�LL i4 .tl�� _ - <br /> LAC -Zr GJ �c/Ec�ssro,eY Ta �L-- <br /> CXC�JvsaT' Q�LL /IDLE D �� ,,,`/9_7InAIV - Piv�2T/�4t Dl(I[/L/YIL/l!T ` mil <br /> Work will commence on or about - 9 lop" for approximately <br /> 30 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 /> gnature of Applicant Title Rate <br /> wXssffit.PS\assn®L (s/ao) RETURN PERMITS TO: <br /> f� <br /> CCD <br /> PG&E - <br /> P.O. BOX 930 <br /> STOCKTON,CA 95201 <br />