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APPLICATION FOR ENCROACHMENT PERMIT <br /> PLEASE PRINT: AA� <br /> Date K" V0 , OFFICE USE ONLY <br /> To: San Joaquin County JOB# REF# <br /> Department of Public Works APN CR# <br /> EXP.DATE <br /> VALID 5 0 iS41 DRIVEWAYS: <br /> Pacific Gas & Electric STREET <br /> AREA e/fro QUAD <br /> P.O. BOX 930 TYPE 1;Z_LL NpL� <br /> STOCKTON, CA 95201 FORMS �� w�T�29 <br /> 209-942-1627 NOTES <br /> 1✓1 j <br /> Cn 61 <br /> lI hA A , <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 /> California supplement <br /> PM 31011619 I <br /> Notif. 1o7c�1o28yo <br /> The undersigned hereby applies for permission to excavate,construct and/or otherwise encroach on County Highway Right-of-Way on <br /> the v N side of IF—. Ml!AIMo approximately 5&7 feet/wile We_ <br /> Of b4 L1 AE%4-( MV It PaN byperformin the following work(description of work): <br /> o G o o ILL <br /> D <br /> Work will commence on or about for approximately q0 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 /> Qcm \far l i l'�+'Vr <br /> JV_-2 (M+r 4/W11 ,4, <br /> Signature of Applicant-Title Date <br /> E:IP . KIMASTERPSIENCROACHMENTPERMITAPPLICATION.DOC(01108) <br /> Return Permits to: <br /> CCD <br /> P.O. Box 930 <br /> Stockton, CA 95201-0930 <br />