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APPLICATION FOR ENCROACHMENT PERMIT <br /> PLEASE PRINT: <br /> Date ����� 2 <br /> OFFICE USE ONLY <br /> To: San Joaquin County JOB# REF# <br /> Department of Public Works APN CR# <br /> EXP.DATE $ �� <br /> VALID T 9 � /2, DRIVEWAYS: <br /> Pacific Gas & Electric STREET , 'eD <br /> P.O. BOX 930 I AREA -7Z;Ze QUAD –jam <br /> STOCKTON, CA 95201 TYPE ,�o�E <br /> FORMS <br /> 209-942-1627 I NOTES —�--T- <br /> 7Sketched plans may be submitted) <br /> Traffic Control Plan <br /> shall be as per <br /> ached sketch. current M.U.T.C.D. <br /> California supplement <br /> Pan 416057aZ. <br /> Notif. 10554 16�67 <br /> The undersi ned hereby applies for permission t excavate,construct and/or otherwise encroach on County Highway Right-o-Way <br /> the side of Right. <br /> cp <br /> of approximately_11 ZU feet/�e <br /> by performing the following work( escription of work): <br /> n <br /> ll ;I At <br /> Work will commence on or about for approximately <br /> 42 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 /> IMSignature of Applicant-Title 1 <br /> Date <br /> IE-'IPU . IMASTERPSIENCROACHMENT PERMITAPPLICATIORDOC(81)08) <br /> Return Permits to: <br /> CCD <br /> P.O. Box 930 <br /> Stockton, CA 95201-0930 <br />