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APPLICATION FOR ENCROACHMENT PERMIT <br /> PLEASE PRINT: <br /> Date OFFICE USE ONLY <br /> To: San Joaquin County JOB# 3®652_ REF# <br /> Department of Public Works APN _ CR# <br /> EXP.DATE s j <br /> VALID l TO LZ�r,; �/ DRIVEWAYS: <br /> Pacif is Gas & Electric STREET a <br /> P.O. BOX 930 AREA QUAD <br /> STOCKTON, CA 95201 TYPE c <br /> 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.p. <br /> California Supplement <br /> Notif. Ir; . <br /> The undersi ned hereby applies f5ir permission taexcavate, construct and/or otherwise encroach_on,C unty Highway Right- f-Way on <br /> the 11104" side of <br /> of _ .�'- approximately � feet/ <br /> :, L, by performing the following work(description of ork): <br /> Work will commence on or about_ for approximately <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 /> tWSr <br /> Signature of Applicant-'TitleERPSIENCROACHMENTPERMITAPPLICATION.00C (01/08) Date <br /> Return Permits to: <br /> CCD <br /> P_O. Box 930 <br /> Stockton, CA 95201-0930 <br />