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APPLICATION FOR ENCROACHMENT PERMIT <br /> PLEASE PRINT: <br /> Date I OFFICE USE ONLY <br /> To: San Joac uin County JOB# 73d05,7 REF# <br /> Department of Public Works APN CR# <br /> EXP.DATE !r i 2 <br /> VALID �� // TO _/ sr Z. _ DRIVEWAYS: <br /> Pacific Gas & Electric STREET <br /> �.O. BOX 930 AREA Sr�iC^1'yw/ QUAD j_=5 <br /> TYPE A&ZG <br /> STOc;'KTON, CA 95201 j FORMS <br /> 209-942-1627 NOTES <br /> Sketch(Detailed l:lans may be submitted) <br /> Traffic Control Plan <br /> s hal I be as per <br /> See attached sketch. current M.U.T.C.p. <br /> PM California supplement <br /> Notif. <br /> The undersigned hE.reby applies for permission to excavate,construct andlor otherwise encroach on County Highway Right-of-Way on <br /> the _ side of`5-12IS0�� "i,: approximately IZA- feet/mile <br /> of byperforming the following work(description of work): <br /> Work will comment e on or about It LL 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 /> LSignature:of Applicant-Title Date <br /> KWAUERPSENCROAC MENF PERMIT APPLICATIORDOC (01108) <br /> Return Permits to: <br /> CCD <br /> P.O. Box 930 <br /> Stockton, CA 95201-0930 <br />