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,At PLICATION FOR FNCROACMUM PERMIT <br /> PLEASE PRINT: <br /> Date �" R ` <br /> OFFICES USE ONLY <br /> To: San Joaquin County VJOBxEF <br /> Department of Public Works _ RE �# <br /> EXP. DATES$�L <br /> PG&E VALID T�O�- $•o$ DRIVEWAYS r <br /> STREET �T <br /> 4040 WEST LANE AREA QTYPE �-, <br /> ":t5F,6C .4ttGG� <br /> STOCKTON, CA 95204 Notes �; z <br /> (City, State, Zip code) <br /> (209)49A - t&2.7 <br /> (Area Code - Telenh eoxseNNumber) <br /> Sketch (Detailed plans may be submitted) <br /> TRAFFIC CONOL PLAN <br /> SHALL BE AS PER <br /> CURREP,11T A,t,U.T.0 [) <br /> CALIFOR�INIA SUPPLEMENT <br /> SEE ATTACHED SKETCH <br /> P <br /> NOTIF: - � <br /> The undersigned hereby applies for permission to excavate, cons. ruct and/or <br /> ot?zer* se encroach on County :Highway Right-of-Wa-y on-the <br /> the <br /> ,., s 4 d� <br /> approximately <br /> Of �1'> feet/mile <br /> s ' . A�r _ <br /> followin yvoYk ._.(.descrip�;ipn of work) f by per€oxmir_g the <br /> • z_l } <br /> Work will commence on or about <br /> " f days, for approximately <br /> I, the undersigned certify that I am the owner of the respective property, or am <br /> qualified to represent taie 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 /> at�eofApp�licanP- Tstle ✓ ? <br /> ate <br /> MAST3R.PS\F83SC5aL ls/ool RETURN PERMITS TO: - <br /> CCD <br /> P&AE <br /> P.O. BOX 930 1 <br /> STOCKTON,CA 95201 <br />