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L <br /> APPLICATION FOR ENCROACHMENT PERMIT <br /> PLEASE PRINT:: <br /> Date `l2 1 Z, OFFICE USE ONLY <br /> To: San Joaquin County JOB# 7-';eZ a REF# <br /> Department of Public Works APN CR# <br /> EXP.DATE <br /> VALID ! T6 DRIVEWAYS: <br /> Pacific Gas & Electric: STREET _M4 144zeop Y <br /> P.O. BOX 930 AREA 2Z01w QUAD _ <br /> TYPE 've-411 1416rz-lf�- <br /> STOCKTON, CA 95201 FORMS 5 Z <br /> 209-942-1627 NOTES <br /> G ,4D <br /> �✓ 4 st' <br /> sAA1 Ae . <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.O. <br /> PM ���2 <br /> California supplement <br /> �1 <br /> Notif. 1051q 1;5o7 <br /> The undersi red hereby applies for permission to excavate,construct and/or otherwise encroach on County Highway Right-of-Way on <br /> the side of 'LAY-4-4h approximately 2353 feet/mft <br /> of rro. 140 11 MAJ f,by performing the following work(description of work): <br /> 2 i-naur. <br /> Work will commence on or about I for approximately L 250 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 /> EV MMASTERPSIENCROACHMENTPERMITAPPLICATION.DOC(01108) <br /> Return Permits to: <br /> CCD <br /> P.O. Box 930 <br /> Stockton, CA 95201-0930 <br />