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APPLICATION FOR ENCROACHMENT PERMIT <br /> PLEASE PRINT: <br /> Date �2 1 I I OFFICE USE ONLY <br /> To: San Joaquin County JOB# 3oa52-!r REF# <br /> Department of Public Works APN _ CR# <br /> EXP.DATE z / / <br /> VALID S / // _ O / / DRIVEWAYS: <br /> Pacific Gas & Electric STREET aditi� ,dD. <br /> P.O. BOX 930 <br /> TYPE AREA a+4 QUAD <br /> J <br /> STOCKTON, CA 95201 FORMS <br /> 209-942-1627 ! NOTES <br /> Sketch(Detailed plans may be submitted) <br /> Traffic Control Plan <br /> shall be as per <br /> See attached sketch. current M.U.T.C.D. <br /> California supplement <br /> Pm1L t <br /> Notif. OC <br /> The undersigned hereby applies for permission to excavate,construct and/or otherwise encroach on County Highway Right-of-Way on <br /> the side of L _approximately 0 feet/mile <br /> of by performing the following work(description of work): <br /> Work will commence on or about_ n�1 i 37 for approximately lbo 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 /> Ul) �416+ty_ - h- III <br /> Signature of Applicant-Title bate <br /> E. . M VZrER.PSeCROACHMWPERMfrAPPUrATION.DOC(0 08) . <br /> Return Permits to: <br /> CCD <br /> P.O. Box 930 <br /> Stockton, CA 95201-0930 <br />