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APPLICATION FOR ENCROACHMENT PERMIT <br /> PLEASE PRINT: <br /> Date /ZZ! I OFFICE USE ONLY <br /> —0 <br /> To: San Joaquin County JOB# REF# <br /> Departm=ent of Public Works APN CR# <br /> EXP.DATE <br /> VALID w 1 Tb DRIVEWAYS: <br /> Pacific Gas & Electric STREET (JB12iL�C� R.� <br /> 11.0. BOX 930 AREA t.Rk,�,g b6QQUAD At W <br /> TYPE ore Crr, � <br /> STOC KTON, 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 /> PM '` � ' <br /> Notif. 574 == <br /> The undersi ned h(:reby applies f r permission to excavate construct and/or otherwise encroach on County Highway Right-.of-Way on <br /> the me _side of ( approximately i feeumft <br /> of ,by performing the following work(description of work): <br /> 6 <br /> Work will commenca on or about for approximately 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 /> Wo \On A wu <br /> Signature of Applicant-Title Date <br /> E NII . I(WASTER.PSIENCROACIi.IENT PERMIT APPLICATION DCC (01)08) <br /> Return Permits to: <br /> CCD <br /> P.O. Box 930 <br /> Stockton, CA 95201-0930 <br />