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APPLICATION FOR ENCROACHMENT PERMIT <br /> PLEASE PRINT: <br /> Date �d I ZA- OFFICE USE ONLY <br /> To: San Joaquin.County JOB# REF# <br /> Department of Public Works APN CR# <br /> EXP.DATE 1110,14 <br /> VALID 3 TO DRIVEWAYS: <br /> Pacific Gas & Electric STREET L W)A1 <br /> P.O. BOX 930 AREA �?Oelelbcnl QUAD, /tlE <br /> TYPE Rme <br /> STOCKTON, CA 95201 FORMS _bob <br /> 209-942-1627 NOTES <br /> �'Y�E Fit! X72 <br /> AAID <br /> XAC-7&9fit'e247"Al <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 �o�� <br /> California supplement <br /> �103 <br /> Notif. Io7ZUZ 55ep <br /> The undersigned hereby applies for permission to excavate,construct and/or otherwise encroach on County Highway Right-of-Way on <br /> � <br /> the V3 side of f Ut)I Ln approximately 1� - feet/mife.6Wf"h <br /> of Afi -1 A= n4L , by performing the following work(description of work): <br /> en u-94va q- rm <br /> QG D,�n oIrk. pori . hQ5 , /1 C�2mc�Ic511��G �G !e. <br /> Work will commence on or about t l 13 for approximately loo 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 /> E:" . KIMASTER.PSIENCROACHMENT PERMIT APPLICATION.DOC (01/08) <br /> Return Permits to: <br /> CCD <br /> P.O. Box 930 <br /> Stockton, CA 95201-0930 <br />