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APPLICATION FOR ENCROACHMENT PERMIT <br /> PLEASE PRINT: <br /> Date OFFICE USE ONLY <br /> To: San Joaquin County JOB# �,3pD�'�to REF# <br /> Department of Public Works APN CR# <br /> EXP.DATE <br /> VALID /! 0, l /��/ DRIVEWAYS: <br /> Pacif is Gas & Electric STREET <br /> P.O. BOX 930 AREA QUAD <br /> STOCKTON, CA 95201 TYPE 7,4u ` Ori ZZ <br /> FORMS 5-S <br /> 209-942-1627 I NOTES <br /> I <br /> Sketch(Detailed plans may be submitted) <br /> Traffic Control Plan <br /> shall be as per <br /> See attached sketch. <br /> current M.U.T.C.D.Pm � <br /> Cal ifornia Supplement <br /> The undersigned hereby applies for permission to excavate,construct and/or otherwise encroach on County Highway Right-of-Way on <br /> the <br /> side of <br /> of L approximately `�;���� fee6/ 6-.� <br /> by performing the following work(description of work): <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 qualified to represent the owner and agree to do the <br /> work described above in accordance with the rules and regulations of San Joaquin County and subject to inspection and approval. <br /> tMWSS—ignature of Applicant-Title - Da e <br /> TEAPSIENCROACRMEM PERMfTAPPUC4TI0N.DOC(01108) <br /> Return Permits to: <br /> CCD <br /> P.O. Box 930 <br /> Stockton, CA 95201-0930 <br />