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APPLICATION FOR ENCROACHMENT PERMIT <br /> PLEASE PRINT: <br /> Date 2 OFFICE USE ONLY <br /> To: San Joaquin County JOB# 71 00f Z p REF# <br /> Department of Public Works APN <br /> CR# <br /> EXP.DATE <br /> VALID S 0 DRIVEWAYS: <br /> Pacific Gas & Electric STREET <br /> P.O. Box 930 AREA 0Je6R 1 QUAD AW <br /> STOCKTON, CA 95201 TYPE <br /> FORMS <br /> 209-942-1627 NOTES <br /> i <br /> Sketch(Detailed plans may be submitted) <br /> Traffic Control Plan <br /> See attached sketch. shall be as per <br /> current M.U.T.C.D. <br /> PM California supplement <br /> Notif. <br /> ThVuersi ed hereby appli s for permission to exc vate,construct and/or otherwise encroach on County Highway Right-of-Way on <br /> thside of oof ,� approximately 22� feet/mde t5g }by performing the following work(description of work):47 rt <br /> o <br /> Work will commence on or about <br /> for approximately 1 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 /> Signature of Applicant-Title 2' <br /> ate <br /> EFU KMASTEPPSIENCROACHkENTPERMITAPPLICATION.DOC (01108) <br /> Return Permits to: <br /> CCD <br /> P.O. Box 930 <br /> Stockton, CA 95201-0930 <br />