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IA APPLICATION FOR ENCROACHMENT PERMIT <br /> PLEASE PRINT: <br /> Date I p ��O l ) ?J' , <br /> OFFICE USE ONLY <br /> To: San Joaquin County JOB# 7�GY�j -�o REF# <br /> Department of Public Works APN CR# <br /> EXP.DATE 2 <br /> VALID 0 3 TO Z DRIVEWAYS: <br /> Pacific Gas & Electric STREET <br /> P.O. BOX 930 AREA �j/aG1aQyJ ,QUAD <br /> STOCKTON, CA 95201 TYPE ALL, utkk <br /> FORMS n <br /> 209-942-1627 NOTES �Q �'� '� �u' <br /> 7Sketcl,'Dettail.ed plans may be submitted) Traffic Control Plan <br /> shall be as per <br /> ched sketch. current M.U.T.C.p_ <br /> PM Z �'"7� <br /> California supplement <br /> �J(O 7 <br /> Notif. <br /> The undersigned hereby applies for permission to excavate, construct and/or otherwise encroach on County Highway Right-of-Way on <br /> the Vside r- Cirapproximate/ � 7 ' <br /> Y— 7 feet/wAp ic�- <br /> of vhI c��G 4 �.�-��-}�� <br /> ��c+.va.-fie , by performing the following work(description of work); <br /> and hDc ns at ri 5s <br /> �zl PN r, a JL <br /> Work will commence on or about Io ! 3 for approximately <br /> 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 /> 10bII-D <br /> tKUP . <br /> ignature of Applicant-Title Date <br /> RPSIENCROACHMENT PERMIT APPLICATION.DOC(01108) <br /> Return Permits to: <br /> CCD <br /> P.O. Box 930 <br /> Stockton, CA 95201-0930 <br />