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APPLICATION FOR ENCROACHMENT PERMIT <br /> PLEASE PRINT: <br /> Date , OFFICE USE ONLY <br /> To: San Joaquin County - JOB# �3�, �. � - REF# - <br /> Department of Public Works APN CR# <br /> EXP.DATE <br /> VALID To DRIVEWAYS: <br /> Pacific Gas & Electric STREET 3bet"k4eA L�Voil. <br /> AREA !£oG�cT6 QUAD <br /> P.Q. BMX 93O TYPE 1" ,& A r7' <br /> STUCKTON, CA 95201FORMS 2� ! <br /> 209-942-1627 NOTES <br /> C <br /> Sketch(Detailed plans may be submitted) <br /> Traff is Control Plan <br /> shall be as per <br /> See attached sketch. current M.U.T.C.D. <br /> California supplement <br /> pM, I�z 14. <br /> Notif. <br /> The undersigned hereby applies for permission to excavate,construct and/or otherwise encroach on County Highway Right-of-Way on <br /> the ftt> side of aAyzr LA . approximately &L feet�a e <br /> of a,r-1 �1� ,� CKJM by performing the following work(description of work): <br /> bot 0, 4V <br /> (v <br /> Work will commence on or about for approximately l80 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 /> 49A, <br /> Signature of Applicant-Title Date <br /> Eft . KIMASTERPSIENCROACHMENfPERMIT APPLICATION.DOC (01/08) <br /> Return Permits to: <br /> CCD <br /> P.O. Box 930 <br /> Stockton, CA 95201-0930 <br />