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APPLICATION FOR ENCROACHMENT PERMIT <br /> PLEASE PRINT: <br /> Date t l f 4411--_t2 , OFFICE USE ONLY <br /> To: San Joaquin County JOB# 736G51,- REF# <br /> Department of Public.Works APN CR# <br /> EXP.DATE <br /> VALID // TO / 14 DRIVEWAYS: <br /> Pacif is Gas & Electric STREET <br /> P.O. BOX 930 AREA QUAD <br /> TYPE0— <br /> STOCKTON, CA 95201 FORMS SS lav✓ -2 YB rt� )z� <br /> 209-942-1627 NOTES <br /> � S <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 41G17 `1v88 California supplement <br /> Notif. <br /> The undersiped hereby applies for permission to excavate,construct and/or otherwise encroach on County Highway Right�-Qf-Way on <br /> the 4+l side of 14• Ur6 h approximately �Z 3 feet/r*le W e-_- <br /> of r�q try A- 10733 w Larch by performing the following work(description of work): <br /> ��or(L b (!-ear gcwb,na, tZ, �oi 10,0). <br /> Work will commence on or about %t'/51 1 v 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 /> y3yJ au / h/, R/14115 <br /> Signature of Applicant-Title bate <br /> E:1PU KIMASTERPSIENCROACHMENTPERMITAPPLICATION.DOC(01108) <br /> Return Permits to: <br /> CCD <br /> P.O. Box 930 <br /> Stockton, CA 95201-0930 <br />