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APPLICATION FOR ENCROACHMENT PERMIT <br /> PLEASE PRINT: <br /> Date 7 r..>" II I <br /> OFFICE USE ONLY <br /> To: San Joaquin County FJOB 2__ � REF# <br /> Department of Public Works <br /> CR# <br /> EXP.DATEVALID 2 iix, DRIVEWAYS: <br /> Pacific Gas & Electric STREET <br /> * <br /> P.O. BOX 930 AREA gnc,*7y QUAD <br /> STOCKTON, CA 95201 TYPE <br /> FORMS <br /> 209-942-1627 NOTES <br /> Sketch(Detailed Flans may be submitted) <br /> Traffic Control Plan <br /> See attached sketch. shall be as per <br /> current M.U:T.C.D. <br /> PM California Supplement <br /> Notif. � I <br /> The ndersi ned hereby applies for permission to excavate, construct and/or otherwise encroach on County Highway Right-of-Way on <br /> the _side of. <br /> of approximately feet/;M <br /> b'performin the following work(description of work): <br /> i!—^•a i <br /> Work will commence on or about <br /> 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 /> Signature of Applicant-Title <br /> Date <br /> E:WU MMASTER PSIENCROACHINENT PERMIT APPLICATIONDOC(01)087 <br /> Return Permits to: <br /> CCD <br /> P.Q. Box 930 <br /> Stockton, CA 95201-0930 <br />