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APPLICATION FOR ENCROACHMENT PERMIT <br /> PLEASE PRINT: <br /> Date t�2 Fj, OFFICE USE ONLY <br /> - To: San Joaquin County JOB# 175A25z_{v REF# <br /> Department of Public Works APN CR# <br /> EXP.DATE <br /> VALID 10 )3 DRIVEWAYS: <br /> Pacif is Gas & Electric STREET ep, <br /> AREA QUAD _ <br /> P.O. BOX 930 TYPE �.Pi.J9GE St1N �lA.�tU)9 <br /> STOCKTON, CA 95201 FORMS ssv ,e-Z <br /> 209-942-1627 NOTES <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 /> - -------- -PNC�18?�1�0----- - ---- - <br /> Notif. <br /> The undersigned hereby applies for permission to excavate,constr ct and/or otherwise encroach on County Highway Right-9f-Way on <br /> the side of approximately 5Z5' feet/r*Q�� <br /> of o , by performing the following work(description of work): <br /> 15�m %J W2134 Ap Z4 L Wa,b X <br /> U.)QrV-J /__MJDLEUt�L Vn/);25 . M?WAA -sr pgu +D Jad <br /> Work will commence on or about Volfor 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 /> Qaq, <br /> Signature of Applicant-Title Date <br /> E:IPUb- . KIMASTER.PSIENCROACHMENTPERMIT APPLICATION.DOC(01/08) <br /> Return Permits to: <br /> CCD <br /> P.O. Box 930 <br /> Stockton, CA 95201-0930 <br />