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APPLICATION FOR ENCROACHMENT PERMIT <br /> PLEASE PRINT : <br /> Date OFFICE USE ONLY <br /> To: San Joaquin County JOB � JrZ- REF # <br /> Department of Public Works APN _ = CR # <br /> EXP. DATE Z•/�S� <br /> VALID To oZ•► © DRIVEWAYS <br /> PG&E STREET t-Ati�ugv3r <br /> AREA �rx QUAD laL_ <br /> 4040 WEST LANE TYPE -z�i , « li�lde <br /> FORMS <br /> STOCKTON, CA 95204 NOTE <br /> (City, State, Zip Code) <br /> s�t 1i i61 42Z- I&ZI <br /> (Asea Code - Telephone Number) <br /> Sketch (Detailed plans may be submitted) <br /> TRAFFIC CONTROL FLAN <br /> SHALL BE AS PER <br /> CURRENT M.U.i C.D <br /> CALIFORNIA SUPPLEMENT <br /> SEE ATTACHED SKETCH <br /> P <br /> The undersigned hereby applies for permission to excavate, gonstruct and/or <br /> other* ise en.crcach an County. Highway Right-of-Wa-y-on the __ .•!^_� side of <br /> approximatelyfeet <br /> / <br /> of <br /> '^ by periormirg the <br /> _following --work,_(descrpuon_ of arork)_: <br /> - - <br /> t -- ---------- <br /> Work will commence on or about'' 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 /> tature of Applicant - Title D to e <br /> MMST3RPS\H83S®L (6/00) RETURN PERMITS TO: <br /> CCD <br /> P6&E <br /> P.O. SOX 930 <br /> STOCKTON,CA 95201 <br />