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APPLICATION FOR ENCROACHMENT PERMIT <br /> PLEASE PRINT: <br /> Date �pj 1 I OFFICE USE ONLY <br /> To: San Joaquin County JOB# 73od52-Co REF# <br /> Department of Public Works APN CR# <br /> EXP.DATE <br /> VALID (o $ 1Y- TO III"/ DRIVEWAYS: <br /> Pacific Gas & Electric STREEToto,¢ /EG <br /> P.O. BOX 930 AREA QUAD WS <br /> TYPE -Se4e,A016 1�= " <br /> STOCKTON, CA 95201 FORMS SS <br /> 209-942-1627 NOTES <br /> i <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 ����u j <br /> Notif. <br /> The undersigned hereby applies for permis5i tQQ excavate,construct and/or otherwise encroach on County Highway Right-of-Way,on <br /> �- <br /> the . side of_l�i�t PVL approximately Gfi I feetlm <br /> of , -4 by performing the following work(description of work): <br /> Work will commence on or about for approximately i 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 /> Q�bq <br /> ��? � �� ►Z <br /> Signature of Applicant-Title ulate <br /> . KIMASTERPSIENCROACHMENTPERMITAPPLICATION.DOC (010) . <br /> Return Permits to: <br /> CCD <br /> P.O. Box 930 <br /> Stockton, CA 95201-0930 <br />