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APPLICATION FOR ENCROACHMENT PERMIT <br /> PLEASE PRINT: <br /> Date �_ OFFICE USE ONLY <br /> To: San Joaquin County JOB# 13A,5Z- REF# <br /> Department of Public Works APN _ CR# <br /> EXP.DATE 2 <br /> VALID /J' / Ter DRIVEWAYS: <br /> Pacific Gas & Electric STREET J✓ �,e <br /> AREA 57lxf QUAD <br /> P.O. BOX 930 TYPE <br /> STOCKTON, 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 - I <br /> Notif. JOE 655r—v' 69 <br /> The un ersi ned hereby appliesor permission to excavate,construct and/or otherwise encroach on County Highway Right-of-Way,on <br /> the _side of _approximately Z(A— feet/atiln <br /> of `_� �o� � by performing the following work(description of work): <br /> Y /, a ;_ t, <br /> Work will commence on or about `? I I for approximately r3 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 wiwh the rules and regulations of San Joaquin County and subject to inspection and approval. <br /> \03D(?WWU '-7/6 h I <br /> LSignature of Applicant-Title If te <br /> U .NASTERPSENCROACH DENT PERMT APPLICATION.DOC (07106) <br /> Return Permits to: <br /> CCD <br /> P.O. Box 930 <br /> Stockton, CA 95201-0930 <br />