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APPLICATION FOR ENCROACHMENT PERMIT <br /> PLEASE PRINT: <br /> OFFICE USE ONLY <br /> Date <br /> To: San Joaquin County JOB# 75060-49 REF# <br /> Department of Public Works APN CR# <br /> EXP.DATE / o� <br /> VALID / 1 TO DRIVEWAYS: <br /> Pacific Gas & Electric STREET G <br /> P.O. BOX 930 AREA ni » QU D Af/,t) <br /> j TYPEOl�45 <br /> STOCKTON, CA 95201 FORMS SS w �- <br /> 209-942-1627 I 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 <br /> Notif. <br /> The undersi ned hereby applies for permission to excavate,construct and/or otherwise encroach on County Highway Right-of-W—a�'on <br /> a roximately `��� feet> e 14� <br /> the side of -� � pp <br /> of 1r)rn j:1M, ,by performing the following work(description of work): <br /> I � 1 <br /> 1 <br /> r -e <br /> Work will commence on or about for approxirfiately 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 /> \03D utvu ) I I <br /> Signature of Applicant-Title Date <br /> E:IPU KIMASTERPSIENCROACHMENTPERMIT APPLICATION-DOC (01108) <br /> Return Permits to: <br /> CCD <br /> P.O. Box 930 <br /> Stockton, CA 95201-0930 <br />