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r pS- 12 6'2 7 S <br /> APPLICATION FOR ENCROACHMENT PERMIT <br /> PLEASE PRINT: <br /> Date g I1 ` r z <br /> . OFFICE USE ONLY <br /> To: San Joaquin County JOB# REF# <br /> Department of Public Works APN CR# <br /> EXP.DATE l2 ► )z- <br /> VALID $ a- TO t2 r )z- DRIVEWAYS: <br /> Pacific Gas & Electric STREET "a-,D A I&. " <br /> P.O. BOX 930 AREA QUAD " <br /> TYPE Lf, Koh <br /> STOCKTON, CA 95201 FORMS ;E-29 <br /> 209-942-1627 i, NOTES <br /> 'POL dY-CAS49 Z '' r (e ✓1 t�2Ntft <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 -"4 I---5 S4 <br /> Notif. S� ZOZ <br /> The undersigned hereby applies for permission to excavate,construct and/or otherwise encroach on County Highway Right-of-Way on <br /> the side of approximately feet, ile <br /> of by p rforming the following work(descriptiop of work): <br /> 46 11-140 aa'62 4:4ab!fel <br /> z <br /> Work will commence on or about 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 /> uq <br /> �� � � '► Y 2 <br /> E:WLSignature of Applicant-Title Da e <br /> MSTERPMENCROACHMENT PERMIT APPLICATIONDOC (01108) <br /> Return Permits to: <br /> CCD <br /> P.O. Box 930 <br /> Stockton, CA 95201-0930 <br />