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APPLICATION FOR ENCROACHMENT PERMIT <br /> PLEASE PRINT: <br /> Date OFFICE USE ONLY <br /> To: San Joaquin County JOB # 71300sf2-4 REF # <br /> Department of Public Works APN CR # <br /> EXP. DATEZ001 <br /> VALID a' "6 TO D-RIVEWAYS <br /> PG&E STREET a U-e_ <br /> AREA ` �' rx.QUAI - <br /> 4040 WEST LANE TYPE <br /> FORMS <br /> STOCKTON, CA 95204 NOTE <br /> (City, State, Zip Code) - - <br /> C209D 4 <br /> (-Area Code - Telephone Number). <br /> Sketch (Detailed plans may be submitted) <br /> TPAF-FIC CONTROL PLAN <br /> SHALL BE AS PEP <br /> CUPP;ENT M.U.T.C.D. <br /> CALIFOPNIA SUPPLEMENT <br /> SEE ATTACHED SKETCH <br /> PM _9 , <br /> NOTIF: <br /> The undersigned hereby applies for permission to excavate, ons�t(,r�,u.�ct and/or <br /> o herwi e- ncroach on Cour_ty Highway Right-of-Way-on the _!&Z -7 = side f <br /> approximatel _ feet/w'4 <br /> of - <br /> by "pezforming the <br /> -_following_�,vription of k)—` -- 47) <br /> Work will c mmence on or about 1O Db for approximately <br /> I kbQdays. <br /> I, the undersigned certify that I am the owner of the re spective, 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 /> S ature of Applicant Title Daae <br /> MASTM.PS\PASS®L (6/00) RETURN PERMITS TO: <br /> CCD <br /> PG&E <br /> P.O. BOX 930 �. <br /> ;TOrKITOM CA Ori?n1 <br />