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APPLICATION FOR ENCROACHMENT PERMIT <br /> PLEASE PRINT: <br /> Date 8/2�'�2 <br /> OFFICE USE ONLY <br /> To: San Joaquin County [AREA <br /> # 'f� ''2„(o REF# <br /> Department of Public Works <br /> CR# <br /> .DATE <br /> D /y TO 3 /5 DRIVEWAYS: <br /> Pacific Gas & Electric EET 0AACD)�q f <br /> P.O. BOX 930 i�c_ o _ QUAD �1 <br /> STOCKTON, CA 95201 TYPE <br /> FORMS '4'f <br /> 209-942-1627 NOTES <br /> FSkelched plans may be submitted) <br /> Traffic Control Plan <br /> ached sketch. shall be as per <br /> current M.U.T.C.p. <br /> California supplement <br /> Notif. <br /> Gt/oraL to �D�'l e on �ja�u rd Cf /1;2— <br /> dU� to 5cA90 16on-1'11 X1-.3 dul) y At rv& <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 <br /> Of approximately 1424 feet/szle�� <br /> by performing the foil wing work descripti n of work)' <br /> Q � <br /> Work will commence on or about <br /> 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 /> '03ba*Wv • % 1�1 2 <br /> Signature of Applicant- ' �� ��h [, 2 <br /> pp t Title <br /> �—Date <br /> EP KIMASTERPSIENCROACHMENTPERMITAPPIJCATION.DOC (01/08) . <br /> Return Permits to: <br /> CCD <br /> P.O. Box 930 <br /> Stockton, CA 95201-0930 <br />