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APPLICATION FOR ENCROACHMENT PERMIT <br /> PLEASE PRINT: <br /> `` t l <br /> Date 6 t/ I �� - OFFICE USE ONLY <br /> To: San Joaquin County JOB# 79GZ6';t-& REF# <br /> Department of Public.Works APN CR# <br /> EXP.DATE <br /> VALID TO DRIVEWAYS: <br /> Pacific Gas & Electric STREETfie. <br /> P.O. BOX 93O AREA � QUAD rte, <br /> TYPE H6 S1.pe-awG %R. <br /> STOCKTON, CA 95201 FORMS <br /> 209-942-1627 NOTES <br /> Sketch(Detailed plans may be submitted) <br /> Traff is Control Plan <br /> shall be as per <br /> See attached sketch. current M.U.T.C.O. <br /> California supplement <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�A c f-� 1 side of hcne- approximately L oZ ` feeftile Qet�, - <br /> of _mdh-- ZZ , by erforming the following work((description of work): <br /> Work will commence on or about i It l 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 /> r <br /> 4Aqi . " 612 ��QAIf <br /> Signature of Applicant-Title Date <br /> E:WU . MMASTERPSIENCROACHMENT PERMIT APPLICATION.DOC (01108) - <br /> Return Permits to: <br /> CCD <br /> P.O. Box 930 <br /> Stockton, CA 95201-0930 <br />