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APPLICATION FOR ENCROACHMENT PERMIT <br /> PLEASE PRINT: <br /> DateF�( OFFICE USE ONLY <br /> To: San Joaquin County JOB# REF# <br /> Department of Public Works APN <br /> _ CR# <br /> EXP.DATE <br /> VALID TO DRIVEWAYS: <br /> Pacific Gas & Electric STREET <br /> '.0. BOX 930 AREA L�_444VA QUAD <br /> STOCKTON, CA 95201 TYPE <br /> FORMS <br /> 209-942-1627 NOTES <br /> Sketch(Detailed I:lans may be submitted) <br /> Traff is Control Plan <br /> See attached sketch. shall be as per <br /> current M.U.T.C.D. <br /> California supplement <br /> PM <br /> Notif. <br /> The undersigned hereby applies for ermission to excavate,construct and/or otherwise encroach on County Highway Right-of-Way on <br /> the side of t�- <br /> of approximately_ -�_feet/�iisJ <br /> by performing the followigg work(des( 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 /> \Ihka"' <br /> Signatun-.!of Applicant-Title <br /> Date <br /> ETU . KWASTERPSIENCROAC GWENT PERMT APPLICATION.DOC (01M) <br /> Return Permits to: <br /> CCD <br /> P.O. Box 930 <br /> Stockton, CA 95201-0930 <br />