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' r <br /> APPLICATION FOR ENCROACHMENT PERMIT <br /> PLEASE PRINT: <br /> Date b !®� , OFFICE USE ONLY <br /> To: San Joaquin County JOB# 7IM52-(p REF# <br /> Department of Public Works APN I I_ CR# <br /> EXP.DATE 111111-4 <br /> VALID0 /I I 3 DRIVEWAYS: <br /> Pacific Gas & Electric STREET d <br /> AREA ,# QUAD <br /> P.O. Box 930 TYPE -Be__1,G <br /> STOCKTON, CA 95201 FORMS SS ww, �Z4 <br /> I <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 ������ Cal ifornia supplement <br /> Not i f. Z <br /> The undersi ned hereby applies for permission to excavate,construct and/or otherwise encroach on County Highway Right-of-Way on <br /> the side of • Li fie.!' approximately Zd ZP feet/ <br /> of fit+ , by performing the following work(description of work): <br /> 0 or L Ui Fvr7j I:> 5e[ve <br /> A b 54155 L.L b4at <br /> Work will commence on or about for approximately 40 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 /> N&O ,I /• <br /> ��� �Oha4+ty- a�11.E <br /> Signature of Applicant-Title Date <br /> E:WU . K4KASTERPSIENCROACHMENTPERMITAPPLICATION.DOC(01/08) . <br /> Return Permits to.- <br /> CCD <br /> o:CCD <br /> P.O. Box 930 <br /> Stockton, CA 95201-0930 <br />