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APPLICATION FOR ENCROACHMENT PERMIT <br /> PLEASE PRINT: <br /> Date 1011011'5 OFFICE USE ONLY <br /> To: San Joaquin County JOB# 73,00 C,1: (p REF# <br /> Department of Public Works APN CR# <br /> EXP. DATE 11 <br /> VALID 0 S TO 3 DRIVEWAYS: <br /> Pacific Gas & Electric STREET <br /> P.O. BOX 930 AREA QUAD —Aff- -- <br /> TYPE <br /> STOCKTON, CA 95201 FORMS ww <br /> 209-942-1627 NOTES <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 /> PM 1:5 California supplement <br /> Notif.lj,�2.55r,�,'q0 <br /> The undersigned hereby applies for permission to excavate, construct and/or otherwise encroach on County Highway Right-of-Wa on <br /> the Ivan side of Gh��f r`�GL. <br /> of 5Gh �,�., � approximately 7�l�' feet/mile ��th <br /> 6c <br /> -k C. L' by performing the following work(description of work): <br /> tex�Gl 2 , ' 1 A bLr <br /> Work will commence on or about / for approximately / 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 /> Signature of Applicant-Title Date <br /> EVU KIMASTER.PSIENCROACHMENT PERMIT APPLICATION.DOC (01/08) <br /> Return Permits to: <br /> CCD <br /> P.O. Box 930 <br /> Stockton, CA 95201-0930 <br />