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APPLICATION FOR ENCROACHMENT PERMIT <br /> PLEASE PRINT <br /> Dane IyC✓ OFFICE USE ONLY <br /> To: San Joaquin County JOB # REF # <br /> Department of Public Works APNCR # <br /> EXP. DATE IZ-[S-Z) <br /> VALID- 6-'27'1D TO I2/S'!)£3 DRIVEWAYS: <br /> PG&E STREET /,-?Y/" oq <br /> AREA ADAM,,7-_ QUAD <br /> Ae- <br /> 4040 WEST LANE TYPE- Cam g_2C <br /> FORMS. <br /> STOCKTON, CA 95204 <br /> NOTE <br /> (City, State, .Zip Code) <br /> Zo�1� t�2- 12�� N�u <br /> . <br /> (Area Code - Telepr)_. <br /> Sketch (Detailed plans may be submitted) <br /> TRAFFIC CONTROL PLAN <br /> SHALL BE AS PER <br /> CURRENT M.U.T.C.D. <br /> CALIFORNIA SUPPLEMENT <br /> SEE ATTACHED SKETCH <br /> PM <br /> NOTIF: -z:�>ot!5l-7 f- <br /> The undersigned hereby applies for permission .to .excavate,�.con,s,t��ruct and/or <br /> otherwise-encroach 'on Count�y -Highway. Right-of-Wa -on the side of <br /> approximately feet/fie <br /> of by er€orming the <br /> __:__�followiag-W. _.(Sl cr ption of,work <br /> jib <br /> Work will commence on or about w' G�5 for approximately <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 /> 77 <br /> S ature of Applicant Titla �c :p) �? <br />