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APPLICATION FOR ENCROACHMENT PERMIT <br /> PLEASE PRINT: <br /> Date VZ-7 OFFICE USE ONLY <br /> To: San Joaquin County JOB# REF# <br /> Department of Public Works APN CR# <br /> EXP.DATE / <br /> VALID -1-113112— 0 S/S v DRIVEWAYS: <br /> Pacific Gas & Electric STREET fT44 ". <br /> P.O. 0 1 <br /> BOX 930 AREA /_,$���� QUAD <br /> TYPE Gt�(rraLE $ 13o�vE <br /> STOCKTON, CA 95201 FORMS IJNJ2-5 <br /> 209-942-1627 NOTES T� <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. e�Ji �Ya I <br /> The undersigned hereby applies for ermission to excavate,construct and/or otherwise encroach on County Highway Right-of-Way on <br /> the ! side of 6, l- approximately -2fi 4 ' feet/W�e <br /> of 'i? by performing the following work(description of work): <br /> .� I► it�� r1.9�cz - ��h��i I re_li.LAf <br /> Work will commence on or about 17, for approximately I t G% 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 /> LSignature of Applicant-Title D to <br /> KWASTEFLPSXENCROACHLENTPERWTAPPUCATION.DOC (01108) <br /> Return Permits to: <br /> CCD <br /> P.O. Box 930 <br /> Stockton, CA 95201-0930 <br />