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APPLICATION FOR ENCROACHMENT PERMIT <br /> PLEASE PRINT22:.. <br /> Date ✓111-11+ <br /> OFFICE USE ONLY <br /> To: San Joaquin County JOB# REF# <br /> Department of Public Works APN CR# <br /> EXP.DATE <br /> VALID l DRIVEWAYS: <br /> Pacif is Gas & Electric STREET LL- 4, <br /> P.O. BOX 930 AREA ,J QUAD _5 <br /> TYPE eib <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.D. <br /> PM 1!5106 California supplement <br /> Notif. <br /> The undersi ned hereby applies for permission to excavate, construct and/or otherwise encroach on County Highway Right-of-Way on <br /> the of fok approximately feet/mile <br /> f by performing the following work(description of work): <br /> On <br /> Work will commence on or about for approximately arm 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 /> 4Aq "OWUW�) <br /> E:N(ISignature of Applicant-Title Date <br /> MASTER.PMENCROACHMENT PERMIT APPLICATION.DOC(01/08) - <br /> Return Permits to: <br /> CCD <br /> P.O. Box 930 <br /> Stockton, CA 95201-0930 <br />