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APPLICATION FOR ENCROACHMENT PERMIT <br /> PLEASE PRINT: <br /> Date `A! 1/I4 OFFICE USE ONLY <br /> To: San Joaquin County JOB# ?366 SZ_!p REF# <br /> Department of Public Works APN CR# <br /> EXP. DATE /y' <br /> VALID Z 6 TO DRIVEWAYS: <br /> Pacific Gas & Electric STREETAj- <br /> AREA �IOG�rOr✓ QUAD Zvs <br /> TYPE E oG6 <br /> STOCKTON, CA 95201 FORMS <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.b. <br /> California supplement <br /> PM 310 4Io -- <br /> Notif. <br /> The undersigned hereby applie.ps�for permission to excavate,construct and/or otherwise encroach on County Highway Right.-qqf-Wa on <br /> the side of 1�QIi(man approximately' feet/ * Nr� <br /> of , by performing the following work(description of work): <br /> X, A 41wiG h -Ir-;, i Qklo &a 64D <br /> Work will commence on or about Z- Bo for approximately Go 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 /> Uqr <br /> E:IPLSignature of Applicant-Title Date <br /> KNASTERPSIENCROACHMErfrPERMITAPPLICKr]ON.DOC (81108) <br /> Return Permits to: <br /> CCD <br /> P.O. Box 930 <br /> Stockton, CA 95201-0930 <br />