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APPLICATION FOR ENCROACHMENT PERMIT <br /> PLEASE PRINT: <br /> Date ���� � OFFICE USE ONLY <br /> To: San Joaquin County JOB# REF# <br /> Department of Public Works APN L CR# <br /> EXP.DATE <br /> VALID /o 1f Te5, DRIVEWAYS: <br /> Pacif is Gas & Electric STREET , <br /> P.O. BOX 930 AREAQUAD :5�; <br /> TYPE <br /> STOCKTON, CA 95201 FORMS <br /> 209-942-1627 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 /> California supplement <br /> PM X07-142v <br /> Notif. <br /> The undersigned hereby applies or permission to excavate,construct and/or otherwise encro ch.on County Highway Right- f�n <br /> the side of Xz��- iL approximately feet/ iie <br /> of K by performin the following work(description of work): <br /> ,. <br /> \Work will commence on or about 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 Date <br /> E:IPD KIMASTERPSWNCROACHMEHTPERMITAPPUCATIOKDOC (01/08) <br /> Return Permits to: <br /> CCD <br /> P.O. Box 930 <br /> Stockton, CA 95201-0930 <br />