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APPLICATION FOR ENCROACHMENT PERMIT <br /> PLEASE PRINT: <br /> Date A/Z,/, OFFICE USE ONLY <br /> To: San Joaquin County JOB# 75:Z5a-<- REF# <br /> Department of Public Works APN CR# <br /> EXP.DATE Z ( 1-2- <br /> VALID <br /> 2VALID S 4 12 TO 12 1 11 1-�- DRIVEWAYS: <br /> Pacific Gas & Electric STREET I I 'E'ALn2a- Ai/ . <br /> AREA -,!5r I QUAD /1l�" " <br /> P.O. Box 930 TYPE 1.c, 61x gi -r—w ,NPI/ <br /> STOCKTON, CA 95201 FORMS lvul 24 <br /> 209-942-1627 ' NOTES <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 /> PM <br /> California supplement <br /> �� � ��13 <br /> Notif. opy--iq—r-44 7Lv <br /> The undersigned hereby applies for permission to excavate,construct and/or otherwise encroach on County Highway Right-of-Way on <br /> the 0-1 h side of approximately_ 75 feeVw& <br /> of by performing the following work(description of work): <br /> OA 4b4�5 J%M1C <br /> pd1L. <br /> Work will commence on or about IA I Iz. for approximately L fb0 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 /> 4/z,,,- <br /> \06DUWU A1,2 �41' <br /> Signature of Applicant-Title bate <br /> E:IP KIMASTERPSIENCROACHMENT PERMIT APPLICATION.DOC (01108) <br /> Return Permits to: <br /> CCD <br /> P.O. Box 930 <br /> Stockton, CA 95201-0930 <br />