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I <br /> J <br /> APPLICATION FOR ENCROACHMENT PERMIT <br /> PLEASE PRINT: <br /> Date Vol 11 OFFICE USE ONLY <br /> To: San Joaquin County JOB# 7,3�z$z—� REF# <br /> Department of Public Works APN CR# <br /> EXP.DATE _ 5-/5 <br /> VALID tl�Zr,)J TO DRIVEWAYS: <br /> Pacific Gas & Electric STREET LZoe� <br /> AREA �-G \ QUAD NW <br /> P.O. SOX 930 TYPE 11{rcVICU— X, tart, <br /> STOCKTON, CA 95201 FORMS 909 <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.D. <br /> PM �J�flS� r California supplement , <br /> Notif. <br /> The u dersi ned hereby appl' s for permission to excavate construct and/or otherwise encroach on County Highway Right-of-Way on <br /> theW4 side of _ ,(a'aifitll• d _approximately feet/gtm- <br /> ofL by performing the fo lowing work(description of work): <br /> V at is <br /> Work will commence on or about for approximately 90 days. <br /> if I - <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 /> Signature of Applicant-Title Date <br /> E:IP KIMASTERPSIENCROACHMENTPERMITAPPLICATION.DOC(01106) <br /> Return Permits to: <br /> CCD <br /> P.O. Box 930 <br /> Stockton, CA 95201-0930 <br />