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r 4. <br /> APPLICATION FOR ENCROACHMENT PERMIT <br /> PLEASE PRINT: <br /> Date I�� 2 OFFICE USE ONLY <br /> To: San Joaquin County JOB REF# <br /> Department of Public Works APN CR# <br /> EXP.DATE g ►7, <br /> VALID to g r 7- DRIVEWAYS: <br /> Pacific Gas & Electric; STREET AP. 11 <br /> P.O. BOX 930 AREA �?,r?,�Qry QUAD <br /> � TYPE Ftp..�eLE <br /> STOCKTON, CA 95201 FORMS zy <br /> 209-942-1627 NOTES <br /> - I <br /> Sketch(Detailed plans may be submitted) <br /> Traff is Control Plan <br /> shall be as per , <br /> See attached sketch, current M.U.T.C.D. <br /> California supplement <br /> PM 4-64-;1504 <br /> 4 <br /> Not if. 10544 11 Z <br /> The�ersi ned hereby applies for permission to excavate,construct and/or otherwise encroach on County Highway Right-of-Way on <br /> the Drside of //DUB iE'J approximately (50e" feed+ . Q <br /> of Alhoti, <br /> performing the following work(description of work): <br /> � �r <br /> Work will commence on or about 2 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 /> \&D&Vwu <br /> Signature of Applicant-Title Date <br /> EAP U . NIMASTERPSIENCROACHMENT PERMIT APPLICATION.DOC(07/88) <br /> Return Permits to: <br /> CCD <br /> P.O. Box 930 <br /> Stockton, CA 95201-0930 <br />