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APPLICATION FOR ENCROACHMENT PERMIT <br /> PLEASE PRINT: <br /> Date OFFICE USE ONLY <br /> To: San Joaquin County JOB# 7.3�i,o5ol_ REF# <br /> Department of Public Works APN CR# <br /> EXP.DATE V01 <br /> 1 <br /> VALID 7 2S it TO /rt DRIVEWAYS: <br /> Pacif is Gas & Electric STREET �`,A)r AP <br /> P.O. BOX 930 AREA QUAD <br /> TYPE l� " <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 /> PM California supplement <br /> Notif. <br /> Theu dersi ed hereby applies or permissio to excav e,construct and/or otherwise encroach on County Highway Right-,of-Way on <br /> the Q l side of approximately to feevwAe-� <br /> Of ,by performing the following work(description of work): <br /> Work will commence on or about –7 17CE11 i J for approximately i6lp—_ 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 /> he <br /> Gjj .. <br /> a _ 311011 1 <br /> Signature of Applicant Title Date <br /> E KMkMs PSENCMAO+F£HrvERWAPPUcnnON.00c"8) <br /> Return Permits to: <br /> CCD <br /> P.O. Box 930 <br /> Stockton, CA 95201-0930 <br />