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APPLICATION FOR ENCROACHMENT PERMIT <br /> PLEASE PRINT: � C_ a- <br /> �1 _ 0 19 93 <br /> Date �7 ! �� OFFICE USE ONLY <br /> To: San Joaquin County JOB# 730e>_-57P_-(. REF# <br /> Department of Public Works APN CR# <br /> EXP.DATE VIM <br /> VALID S2-K 0 z/41 t 3 DRIVEWAYS: <br /> Pacific Gas & Electric STREET F- , ' <br /> AREA L QUAD AftL) <br /> P.O. BOX 930 TYPE 1!:e U_ oLE. T.26PCA4 <br /> STOCKTON, CA 95201 FORMS ww, L4 <br /> 209-942-1627 NOTES <br /> rq b &-r ,t2_,4 dAWY <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 5c)q 379 o <br /> Notif. 1 p6o5190-7 <br /> The undersi ned hereby applies for permission to excavate,construct and/or otherwise encroach on Count Highway Right- f-Way on <br /> the side of approximately 2775 feet/m0a MN <br /> Of- by performing the following work(descripti n of work): <br /> k4- L6AUC _64zatUrb2 RA. a <br /> 2 <br /> Work will commence on or about Zo I rz. for approximately t P�ty 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 /> �GUUl1f�U ' l .J '�✓I r 7i <br /> Signature of Applicant-Title Oate <br /> E. KWMPPMCROACliW-WPERMTAPPUCATION.DOC (010) <br /> Return Permits to: <br /> CCD <br /> P.O. Box 930 <br /> Stockton, CA 95201-0930 <br />