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APPLICATION FOR ENCROACHMENT PERMIT <br /> PLEASE PRINT: <br /> Date �-5 t 1-71 t 1 I OFFICE USE ONLY <br /> To: San Joaquin County JOB# fL23j OC62-6 REF# <br /> Department of Public Works APN -23b-► CR# <br /> EXP.DATE -1 —2cU LZ <br /> VALID �-2S-2o4 TO DRIVEWAYS: <br /> Pacific Gas & Electric j STREET Ka 4pL Ave.. <br /> P.O. BOX 930 AREA S+oC1<V&� QUAD _SS <br /> TYPE <br /> STOC KTON, CA 95201 FORMS <br /> 209-942-1527 I NOTES <br /> i <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 /> Noti f. � c) -7 Z—;7214 <br /> The <br /> ;72I4 <br /> The undersigpqd hereby applies for permission tQ excavate,construct and/or otherwise encroach on County Highway Right-of-Way on <br /> the f _side of_4=mapproximately I L7 feet/�S 1- - <br /> of '` " , ,by performin_g the o Ilowing.work(description of work): <br /> Work will commence on or about for approximatelyf� 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 Date <br /> rz . WA&STUUPSIENCROAGNAENr PERWAPPUCATION.DOC(0108) <br /> Return Permits to: <br /> CCD <br /> P.O. Box 930 <br /> Stockton, CA 95201-0930 <br />