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APPLICATION FOR ENCROACHMENT PERMIT <br /> PLEASE PRINT: <br /> Date ZI �I �� OFFICE USE ONLY <br /> - <br /> To: San-Joaquin County JOB# 051-lv REF# <br /> Department of Public Works APN CR# <br /> EXP.DATE 1513 <br /> VALID TO DRIVEWAYS: <br /> Pacif is Gas & Electric STREET &AgZAjW 4 <br /> AREA 45k--0/V QUAD <br /> P.O. BMX 930 TYPE 06ez'MGY6 <br /> STOCKTON, CA 95201 FORMS <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 /> PM '7 7 I California supplement <br /> Notif. to&4--05575 <br /> The undersigned hereby applies for permission to excavate, construct and/or otherwise encroach on County Highway Right-of-Way on <br /> the 600-41 side of approximately. 6pb" feet/pg �Q <br /> of -lin , by performing the following work(description of work): <br /> AV 601v\dat-o-A -74 15 <br /> Work will commence on or about - 5 for approximately (P t? 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 /> r <br /> E:"LSignature of Applicant-Title Date <br /> E:IPU KIMASTERPSIENCROACHMENTPERMIT APPLICATION.DOC (01/08) <br /> Return Permits to: <br /> CCD <br /> P.O. Box 930 <br /> Stockton, CA 95201-0930 <br />