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dr <br /> APPLICATION FOR ENCROACHMENT PERMIT <br /> PLEASE PRINT: <br /> Date IZ� 12 OFFICE USE ONLY <br /> To: San Joaquin County JOB# 7300�U REF# <br /> Department of Public Works APN CR# <br /> EXP.DATE /f ) <br /> VALID y T /,r DRIVEWAYS: <br /> Pacific Gas & Electric: STREET <br /> P.O. BOX 930 AREA TA QUAD —*,,J <br /> TYPE OZ14— <br /> STOCKTON, CA 95201 FORMS <br /> 209-942-1627 NOTES <br /> D G R <br /> /B z rr/ <br /> �✓ T4s <br /> �i�E�¢6E� • � <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 /> Pm California supplement <br /> Notif. �vrJlv0�31� <br /> The undersi ned hereby applies for ermission to excavate,construct and/or otherwise encroach on County Highway Right-o-Way n <br /> the side of � S.. approximately �' feet/mile <br /> ofp� ing the fol�lorwing work(description of work): <br /> ,. <br /> 2 <br /> Work will commence on or about for approximately t 80 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:IPU KIMASTER.PSIENCROACHMEMPERMITAPPLICATION.DOC (01/08) <br /> Return Permits to: <br /> CCD <br /> P.O. Box 930 <br /> Stockton, CA 95201-0930 <br />