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PLEASE PRINT: APPLICATION FOR ENCROACHMENT PERMIT <br /> Date I OFFICE USE ONLY <br /> To: San Joaquin County <br /> Department of Public Works FA �-� <br /> REF# <br /> CR# <br /> fzPacific Gas �c Electric VALIDALID /a TQ !Z / DRIVEWAYS:.¢'P.O. BOX 930 r.�✓ QUAD �$ <br /> STOCKTON, CA 95201FOMS <br /> TYPE " " l" --�-' <br /> 209-942-1627 NOTES <br /> -- <br /> 7See <br /> tailed plans may submitted) <br /> Traffic Control Plan <br /> ttached Sketch. Shall be as per <br /> current M.U.T.C.p. <br /> PM California supplement <br /> Not if. <br /> The undersigned hereby applies fotherwise the or ermission to excavate, construct and/or othenc <br /> side ofroach on County Highway Ri ht-of-W <br /> of Sys �'�.t-- approximately g ay on <br /> feet/x4a if <br /> X - by pertorming the following work(description of work): <br /> - L' <br /> r <br /> moy <br /> Work will commence on or about <br /> for approximately I <br /> I,the undersigned, certify that I am the owner of the respective property,or am qualified to re resen days. <br /> work described above in accordance with the rules and regulations of San Joaquin County and subject a owner and agree to do the <br /> to inspection and approval. <br /> tSignature of Applicant-Title <br /> KU"EAPU .�, " Date <br /> TERPENCROACRMEMPE'M,WAPPLICATION.DOC pl,08) <br /> Return Permits to: <br /> CCD <br /> P.O. Box 930 <br /> Stockton, CA 95201-0930 <br />