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APPLICATION FOR ENCROACHMENT PERMIT <br /> PLEASE PRINT: <br /> Date �12��`2 OFFICE USE ONLY <br /> To: San Joaquin County JOB# 05Z-4�, REF# <br /> Department of Public Works APN CR# <br /> EXP.DATE 8 i Z- <br /> VALID I z 0 g 1, oz DRIVEWAYS: <br /> Pac if is Gas & Electric STREET Lq(1r } 'Ram. <br /> P.O. BOX 93O AREA MWP1 � 6yQUAD .r <br /> TYPE 14 a <br /> STOC KTON, 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 4 lsq-?50r3 <br /> Notif. 1054A31 I I <br /> The undersi ed hereby applies for permission tavate,construct and/or otherwise encroach on County Highway Righ-o-W yon <br /> the. side of (rd. z-r) K approximately 21oz- feet/re <br /> of QUh eANA. JA2a6LJ, ,by performing the following work(description of work): <br /> Uagc tLl�-? o a� 1 1 jv-u <br /> Work will commence on or about 27 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 /> \0mawli <br /> 1 <br /> E,LSignature of Applicant-Title Date <br /> K)MASTEPPSIENCROACHMENTPMMITAPPUCATION.DOC(0108) <br /> Return Permits to: <br /> CCD <br /> P.O. Box 930 <br /> Stockton, CA 95201-0930 <br />