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APPLICATION FOR ENCROACHMENT PERMIT <br /> PLEASE PRINT: <br /> Date OFFICE USE ONLY <br /> To: San Joaquin County JOB# 730 UsL-CP REF# <br /> Department of Public Works APN CR# <br /> EXP.DATE ll <br /> VALID 6 TO 13 DRIVEWAYS: <br /> Pacific Gas & Electric STREET rC Z.D. <br /> P.O. BOX 930 AREA srac_kTor3 QUAD !% <br /> TYPE L�t-lrt,G- t Cie E <br /> STOCKTON, CA 95201 FORMS -5,slwW <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 /> PM �9 -7110 <br /> Notif. �oC�lo3�02 <br /> The undersigned hereby applies for permission to excavate,construct and/or otherwise encroach on County Highway Right-of-Way on <br /> the side of T ne RA, approximately I 1,!)o feeVask L4 f <br /> Of , by peMPVI <br /> e following work(description of work): <br /> IA ll 0I4Z <br /> Work will commence on or about LD 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 /> \OyjAwu ` , <br /> E:WLSignature of Applicant-Title Date <br /> KIMASTER.PSXENCROAGHMENT PERMIT APPLICATION.DOC(01108) <br /> Return Permits to: <br /> CCD <br /> P.O. Box 930 <br /> Stockton, CA 95201-0930 <br />