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f <br /> APPLICATION FOR ENCROACHMENT PERMIT <br /> PLEASE PRINT: <br /> Date OFFICE USE ONLY <br /> To: San Joaquin County JOB# �r2—�o REF# <br /> Department of Public Works APN CR# <br /> EXP.DATE <br /> VALID _ DRIVEWAYS: <br /> Pacific Gas & Electric <br /> STREETN4_2 A" <br /> P.O. eox 930 i AREA TYPE �u d�- QUAD <br /> STOC KTaN, CA 95201 FORMS Z <br /> 209-942-1627 NOTES <br /> Sketch(Detailed plans may be submitted) <br /> Traf f is Control Plan <br /> shall be as per <br /> See attached sketch. current M.U.T.C.D. <br /> California supplement <br /> PM t" <br /> Not if. long2� <br /> The undersi ped hereby applies for permission to excavate, construct and/or otherwise encroach on County Highway Right-of-Way on <br /> the M�_.2 side 6. a lu- -N)"e . approximately 155 feet/r t4 U' <br /> of Ponw— A-y t✓ i , by rforming the following work(description of work): <br /> Work will commence on or about for approximately D 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 /> E:IPLSignature of Applicant-Title !I&21 Date <br /> KIMASTER.PSIENCROACHMENT PERMIT APPLICATION.DOC (01/08) <br /> Return Permits to; <br /> CCD <br /> P.O. Box 930 <br /> Stockton, CA 95201-0930 <br />