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AF?PLICATION FOR ENCROACHMENT:'PERMI7C <br /> PLEASE PRINT:' . <br /> Date _LJ�� OFFIC$ USE ONLY <br /> TO: San Joaquin County JOB # ', REF # <br /> Department of Public WorksP <br /> . AN CR # <br /> EXP. DATE <br /> VALID '7-28 TO jt-I-D�i DRIVEWAYS <br /> PG&Ecy �E <br /> 4040 WEST LANE TYPE <br /> FORMS <br /> STOCKTON, CA 95204 NbTE <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 SUPPLEMENT <br /> SEE ATTACHED SKETCH <br /> PM 3D632_96I <br /> NOTIF: <br /> The undersigned hereby applies for permission to.excavate, construct and./or <br /> otherwise-encroach on C:ounty-Highway Right-of-Way-oa-the side.of <br /> 144A02T Lyy approximately /SS feet/Li <br /> of APig All h' z2A I za-_ 2J1 _ �RElV/�l !`J91�i _ by Pe-rf ormirig the <br /> _�__ ��ol lnwyng�,,rQxls,_�.�1��crption of:work. -- <br /> X - <br /> e /:Dle rlscQy�c�. <br /> Work will commence on or about 2B' cr(/Ly '03 for approxiTnately <br /> 9� <br /> days. - <br /> I, <br /> ays.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 t8 <br /> . MAS=M.PS\Fees®L (6/00) `RETURN PERMITS TO-. - <br /> CCP, <br /> P6�E <br /> P n"Rnx q: o <br />