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APPLICATION FOR ENCROACHMENT PERMIT <br /> PLEASE PRINT: <br /> Date nt t5T-/ I_ OFFICE USE ONLY <br /> To: San Joaquin County JOB# Z: �Z REF# <br /> Department of Public Work; APN CR# <br /> EXP. DATE <br /> TRE <br /> Pacific Cas and Electric Co. Ss", 0 DRIVEWAYS: <br /> STREET <br /> P.O. Box 930 AREA ,z•T„/ QU D xC-5 <br /> Stockton, CA 95201 TYPE <br /> FORMS <br /> NOTES <br /> 20� ° <br /> 01/2- l z 1?3 <br /> — (Area Code-Telephone Number) <br /> Sketch (Detailed plans may be submitted) <br /> Traffic Control Plan <br /> See attached sketch. Shall be as per <br /> PM 305(x.2525 current M.U.T.C.D. <br /> Notif. JAL; .1 S2 California supplement. <br /> The undersigned hereby applies for permission to excavate,construct and/or otherwise encroach on County Highway Right-of-Way on <br /> the SOO7_1 _side of Sz. I—XOAJ /4 ilE approximately �5yz feeY4:nk S T <br /> of ZJALKE;Q Ln1� by performing the following work(description of work): <br /> r,'14_5 4,AJID <br /> fur dFf: ��S Sc2rJ>�c, <br /> Work will commence on or about_ B-/S-11 for approximately .30 days. <br /> I,the undersignecl 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 Date. <br /> E:W11SVNI(WASTERYSIENCROA(NMENT PERMIT APPLICATION.DOC (41M <br />