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APPLICATION FOR ENCROACHMENT PERMIT <br /> PLEASE PRINT: <br /> Date ho 115 OFFICE USE ONLY <br /> To: San-Joaquin County -JOB# REF# <br /> Department of Public Works APN CR# <br /> EXP.DATE I.Y )3 <br /> VALID 13 T1b15 13 DRIVEWAYS: <br /> Pacif is Gas & Electric STREET AA-, <br /> AREA 5-n-AeMIJ QUAD <br /> P.O. BOX 930 TYPE -eta . How P . <br /> STOCKTON, CA 95201 FORMS d <br /> 209-942-1627 NOTES <br /> Sketch(Detailed plans may be submitted) <br /> Traf f is Control Plan <br /> s hal I be as per <br /> See attached sketch. current M.U.T.C.D. <br /> California supplement <br /> PM 44 65 Zoll <br /> Not i f. 105q 52o4.7 <br /> The undersi ned hereby applies for permission to excavate,construct and/or otherwise encroach on County Highway Right-of-Way on <br /> the U side of approximately 11±5' feet/mile Wei <br /> of , by performing the following work(description of work): <br /> Work will commence on or about 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 /> _Ian \1ayJL1*" , /Jrr' 6&,t? tho/15 <br /> Signature of Applicant-Title Date <br /> UP( KIMASTER.PSIENCROACHMENTPERMIT APPLICATION.DOC (01/08) <br /> Return Permits to: <br /> CCD <br /> P.O. Box 930 <br /> Stockton, CA 95201-0930 <br />