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APPLICATION FOR ENCROACHMENT PERMIT <br /> PLEASE PRINT: <br /> Date 10 1 I Q ) 1 .5 OFFICE USE ONLY <br /> To: San Joaquin County .JOB# 30059, REF# <br /> Department of Public Works APN CR# <br /> EXP.DATE 114 . <br /> VALID It tl l Tb DRIVEWAYS: <br /> Pacific Gas & Electric STREET <br /> AREA QUAD tdW <br /> P.O. BOX 930 TYPE <br /> STOCKTON, CA 95201 FORMS Wvo, <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 to E106"5 <br /> California supplement <br /> Notif. 1c -7o <br /> Theu dersigned hereby applies or permission to excavate,construct and/or otherwise encroach on County Highway Right-of-Way on <br /> the �' side of W(,On f T approximately � 6z?-, <br /> feet/r o(' <br /> of onn J321) Of' +VO , by perform1"atLr <br /> the following work(description of work): <br /> 1A'-2b&1[ Qee,�'We'd 0./606.2 . via <br /> Work will commence on or about i I 17 1 for approximately 1f8r—) 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 /> \Oyjwu <br /> E:IPLSignature of Applicant-Title bate <br /> KWASTEFLPSIENCROACHMENTPERWTAPPLICATION.DOC (01108) Return Permits to: <br /> CCD <br /> P.O. Box 930 <br /> Stockton, CA 95201-0930 <br />