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APPLICATION FOR ENCROACHMENT PERMIT <br /> PLEASE PRINT: <br /> Date � I/I I 2 OFFICE USE ONLY <br /> To: San Joaquin County JOB# 49 REF# <br /> Department of Public Works APN CR# <br /> EXP.DATE 1 <br /> VALID 91;,141121TO / / DRIVEWAYS: <br /> Pacific Gas & Electric STREET Aallw&la 19P. <br /> P.O. BOX 930 AREA o,¢�t/r10 QUAD /V <br /> TYPE <br /> STOCKTON, CA 95201 FORMS n� Z <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.A fu: -, rets , current M.U.T.C.D. <br /> California supplement <br /> PM 8e;14- <br /> Notif. <br /> The un rsigned hereby applies for permission to excavate,construct and/or otherwise encroach on County Highway Right-of-Way on <br /> the side ofOt)e-t I approximately 1 S' feet/mile6nW <br /> of `�t� , 1wim4zpo by performing the following work(description of work): <br /> Work will commence on or about for approximately L 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 /> Signature of Applicant-Title Date <br /> E:IP KM45fERP81ENCR0ACNMENTPERMRAPPLICATION.DOC (0708) <br /> Return Permits to.- <br /> CCD <br /> o:CCD <br /> P.O. Box 930 <br /> Stockton, CA 95201-0930 <br />