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APPLICATION FOR ENCROACHMENT PERMIT <br /> PLEASE PRINT:I <br /> Date IZ!+ I 15 OFFICE USE ONLY <br /> To: San Joaquin County JOB# 73aoSZ-(o REF# <br /> Department of Public Works APN CR# <br /> EXP. DATE <br /> VALIT6 DRIVEWAYS: <br /> Pacific Gas & Electric STREET STbL— <br /> P.O. BOX 930 AREA Srr4aWr'zw0 QUAD cc,, <br /> TYPE '�E� <br /> STOCKTON, CA 95201 FORMS w 12.29 n a <br /> 209-942-1627 NOTES <br /> * y26R 51VCy 1402 - Nve�� AC n <br /> Pt�(-f <br /> Sketch(Detailed plans may be submitted) <br /> Traffic Control Plan <br /> shall be as per <br /> See attached sketch. current M.U.T.C.D. <br /> California supplement <br /> PM 41-!r-)&X708 <br /> Notif. <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 1 P approximately 11591 feet/wife We6i <br /> ofG� n by performing the following work(description of work): <br /> D t r �" AuvA <br /> Work will commence on or about 1 for approximately -5o 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 /> 10411�5a <br /> Signature of Applicant-Title Date <br /> EW KIMASTER.PSIENCROACRMENT PERMIT APPLICATIONDOC(01108) <br /> Return Permits to: <br /> CCD <br /> P.O. Box 930 <br /> Stockton, CA 95201-0930 <br />