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APPLICATION FOR ENCROACHMENT PERMIT <br /> PLEASE PRINT: <br /> Date OFFICE USE ONLY <br /> To: San Joaquin County JOB# � 4REF# <br /> Department of Public Works APN CR# <br /> EXP.DATE II/l/13 <br /> VALID 1(o 13 T )3 DRIVEWAYS: <br /> Pacif is Gas & Electric STREET — 7MMJM jCD. <br /> AREA MARBCPi QUAD 515 <br /> P.O. BOX 930 TYPE a� <br /> STOCKTON, CA 95201 FORMS —2 —n2j9&ZR C .1-n2 l$ <br /> 209-942-1627 NOTES G <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 /> PNMg���I� <br /> Notif. <br /> The undersigned hereby applies for permission to excavate,construct and/or otherwise encroach on County Highway Right-of-Wa on <br /> the k�� side of rti it a �� approximately feet/re <br /> Of_11011 oy UN,21k�A' , by performing the following work(description of work): <br /> A o! Imo. <br /> Work will commence on or about L., 3 for approximately 98,E 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 /> \/hJ0*1VUi&/I Z <br /> Signature of Applicant-Title Date <br /> E1P <br /> KIMASTERPSIENCROACHMENT PERMIT APPLICATION.DOC(01/08) <br /> Return Permits to: <br /> CCD <br /> P.O. Box 930 <br /> Stockton, CA 95201-0930 <br />