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APPLICATION FOR ENCROACHMENT PERMIT <br /> PLEASE PRINT:: <br /> Date - i I W I I 7/ OFFICE USE ONLY <br /> To: San Joaquin County JOB# 73f,Yw -<6 REF# <br /> Department of Public Works APN _ CR# <br /> EXP.DATE y <br /> VALID 1"t lb TO 4WIA DRIVEWAYS: <br /> Pacif is Gas & Electric STREET <br /> P.O. BOX 930 AREA -k-tz,pc,q QUAD 5W <br /> TYPEL.C-- <br /> STOCKTON, CA 95201 FORMS <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. current M.U.T.C.D. <br /> California supplement <br /> PM <br /> Notif. �0�5282�5 <br /> The undersigned hereby applies for permission to excavate, construct and/or otherwise encroach on County Highway Right- f-Way on <br /> the side of �fY'A,I 1�I jdZy approximately 49- feet/ode <br /> of Glv FNA , by performing the following work(description of work): <br /> e>e,iti10-0 It <br /> . Work will commence on or about for approximately 150 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 D to <br /> E:W KIMASTERPSIENCROACHMENT PERMIT APPLICATION.DOC (01108) - <br /> Return Permits to: <br /> CCD <br /> P.O. Box 930 <br /> Stockton, CA 95201-0930 <br />